MCID: VPM001
MIFTS: 48

Vipoma

Categories: Cancer diseases, Endocrine diseases, Gastrointestinal diseases, Rare diseases

Aliases & Classifications for Vipoma

MalaCards integrated aliases for Vipoma:

Name: Vipoma 12 73 20 58 54 44 15 70
Pancreatic Vipoma 20 17 70
Diarrheogenic Islet Cell Tumor 20 58
Vip-Secreting Tumor 20 58
Pancreatic Cholera 58 70
Malignant Vasoactive Intestinal Peptide-Secreting Tumor 12
Watery Diarrhea-Hypokalemia-Achlorhydria Syndrome 58
Vasoactive Intestinal Peptide-Secreting Tumor 12
Vasoactive Intestinal Peptide-Producing Tumor 20
Vasoactive Intestinal Peptide Tumor 20
Verner-Morrison Syndrome 58
Vip- Secreting Tumor 12
Vipoma, Malignant 12
Malignant Vipoma 70
Wdha Syndrome 58

Characteristics:

Orphanet epidemiological data:

58
vipoma
Inheritance: Not applicable; Prevalence: <1/1000000 (Europe); Age of onset: All ages; Age of death: any age;

Classifications:

Orphanet: 58  
Rare gastroenterological diseases
Rare endocrine diseases


Summaries for Vipoma

GARD : 20 A VIPoma is a rare cancer caused by a type of pancreatic neuroendocrine tumor, which is tumor that arises from cells that produce hormones - allowing the tumor itself to produce hormones. A VIPoma secretes vasoactive intestinal peptide (VIP), a hormone that stimulates the secretion (and inhibits the absorption) of sodium, chloride, potassium and water within the small intestine. Excessive secretion can increase bowel motility and lead to signs and symptoms such as abdominal pain and cramping, severe watery diarrhea, dehydration, flushing of the face, muscle cramps due to low potassium levels ( hypokalemia ), and weight loss. When a person has a VIPoma and these associated symptoms, it is referred to as VIPoma syndrome, also called WDHA syndrome or Verner-Morrison syndrome. The majority of people with a VIPoma have VIPoma syndrome. VIPomas are usually diagnosed in middle-aged adults or in young children. Tests used to diagnose a VIPoma may include blood tests (including VIP level), imaging studies such as a CT scan or MRI, and examination of a stool sample. Unfortunately, even though these tumors are slow-growing, the majority of VIPomas are metastatic (have spread to other parts of the body) at the time of diagnosis. The underlying cause of VIPomas is not yet known. Management typically first involves treating dehydration with fluids and correcting the imbalance of hormones and other substances (metabolic abnormalities) in the body. Medications such as octreotide and lanreotide can usually stop the diarrhea and inhibit the secretion of VIP. Surgery typically follows in order to remove the tumor. When there is no evidence of metastasis, complete removal of the tumor is the only possible cure. The majority of metastatic cases will not be cured by surgery, but symptoms may be managed and prolonged survival is often possible due to the slow-growing nature of these tumors. Targeted therapy or chemotherapy may also be used for people with progressive, advanced disease. The median survival of people with VIPomas is 96 months, but long-term survival mainly depends on the tumor grade, staging, and whether all or most of the tumor can be removed.

MalaCards based summary : Vipoma, also known as pancreatic vipoma, is related to malignant pheochromocytoma and diarrhea, and has symptoms including diarrhea An important gene associated with Vipoma is VIP (Vasoactive Intestinal Peptide), and among its related pathways/superpathways are Signaling by GPCR and Peptide ligand-binding receptors. The drugs Gefitinib and Sorafenib have been mentioned in the context of this disorder. Affiliated tissues include pituitary, pancreas and small intestine, and related phenotypes are hypokalemia and neoplasm of the pancreas

Wikipedia : 73 A VIPoma or vipoma (/vɪˈpoʊmə/) is a rare endocrine tumor that overproduces vasoactive intestinal... more...

Related Diseases for Vipoma

Diseases related to Vipoma via text searches within MalaCards or GeneCards Suite gene sharing:

(show top 50) (show all 198)
# Related Disease Score Top Affiliating Genes
1 malignant pheochromocytoma 30.9 SST CHGA CALCA
2 diarrhea 30.4 SST SCT NTS GAST CALCA
3 pancreatic cholera 30.3 VIP SST SCT PPY MEN1 GHRH
4 ileus 30.2 VIP SST CALCA
5 ganglioneuroma 30.2 VIP SST CHGA
6 pheochromocytoma 30.0 VIP SST MEN1 CHGA CALCA
7 parathyroid adenoma 30.0 MEN1 CHGA CALCA
8 small cell carcinoma 29.9 GAST CHGA CALCA
9 glucagonoma 29.9 VIP SST SCT GAST CHGA
10 appendix adenocarcinoma 29.8 SMAD4 CHGA
11 hyperinsulinemic hypoglycemia 29.7 SST PPY MEN1
12 neuroendocrine carcinoma 29.6 SST MEN1 GAST CHGA CALCA
13 paraganglioma 29.6 SST MEN1 CHGA CALCA
14 hyperparathyroidism 29.6 SCT MEN1 GAST CHGA CALCA
15 multiple endocrine neoplasia 29.5 VIP SST SCT MEN1 GAST CHGA
16 hyperprolactinemia 29.4 VIP SST GHRH GH1
17 insulinoma 29.4 SST SCT MEN1 GAST CHGA
18 pancreatic endocrine carcinoma 29.3 SST PPY MEN1 GAST CHGA
19 primary hyperparathyroidism 29.2 MEN1 GHRH GAST CHGA CALCA
20 gastrinoma 29.1 VIP SST SCT MEN1 GAST CHGA
21 neuroendocrine tumor 29.0 VIP SST SCT NTS MEN1 GHRH
22 carcinoid syndrome 29.0 SST NTS MEN1 GHRH CHGA CALCA
23 multiple endocrine neoplasia, type i 28.8 VIP SST SCT PPY MEN1 GHRH
24 zollinger-ellison syndrome 28.6 SST SCT NTS MEN1 GHRH GAST
25 adenoma 28.3 SST SMAD4 MEN1 GHRH GH1 CHGA
26 islet cell tumor 28.1 VIP SST SCT PPY MEN1 GHRH
27 small intestinal vasoactive intestinal peptide producing tumor 11.5
28 pancreatic vasoactive intestinal peptide producing tumor 11.1
29 hypokalemia 10.5
30 metabolic acidosis 10.3
31 neurogenic bowel 10.3 VIP GAST
32 secretory diarrhea 10.3
33 leprosy 2 10.3 VIP CALCA
34 autoimmune atrophic gastritis 10.3 GAST CHGA
35 ampulla of vater benign neoplasm 10.3 SST CHGA
36 atypical follicular adenoma 10.3 NTS CALCA
37 gastric antral vascular ectasia 10.3 SST GAST
38 extracranial neuroblastoma 10.3 VIP CHGA
39 duodenal benign neoplasm 10.3 SST CHGA
40 cervical neuroblastoma 10.3 VIP CHGA
41 mixed ductal-endocrine carcinoma 10.3 GAST CHGA
42 cluster headache 10.3 VIP CALCA
43 goblet cell carcinoid 10.3 GAST CHGA
44 gastric hemangioma 10.3 SST CHGA
45 vasomotor rhinitis 10.2 VIP CALCA
46 multiple mucosal neuroma 10.2 MEN1 CALCA
47 adrenal gland pheochromocytoma 10.2
48 meckel diverticulum 10.2 SST CHGA
49 nasal cavity adenocarcinoma 10.2 GAST CALCA
50 small intestine neuroendocrine neoplasm 10.2 SST MEN1

Graphical network of the top 20 diseases related to Vipoma:



Diseases related to Vipoma

Symptoms & Phenotypes for Vipoma

Human phenotypes related to Vipoma:

58 31 (show all 42)
# Description HPO Frequency Orphanet Frequency HPO Source Accession
1 hypokalemia 58 31 hallmark (90%) Very frequent (99-80%) HP:0002900
2 neoplasm of the pancreas 58 31 hallmark (90%) Very frequent (99-80%) HP:0002894
3 secretory diarrhea 58 31 hallmark (90%) Very frequent (99-80%) HP:0005208
4 nausea and vomiting 58 31 frequent (33%) Frequent (79-30%) HP:0002017
5 diabetes mellitus 58 31 frequent (33%) Frequent (79-30%) HP:0000819
6 hepatomegaly 58 31 frequent (33%) Frequent (79-30%) HP:0002240
7 malabsorption 58 31 frequent (33%) Frequent (79-30%) HP:0002024
8 dehydration 58 31 frequent (33%) Frequent (79-30%) HP:0001944
9 anorexia 58 31 frequent (33%) Frequent (79-30%) HP:0002039
10 chronic fatigue 58 31 frequent (33%) Frequent (79-30%) HP:0012432
11 hypercalcemia 58 31 frequent (33%) Frequent (79-30%) HP:0003072
12 erythema 58 31 frequent (33%) Frequent (79-30%) HP:0010783
13 weight loss 58 31 frequent (33%) Frequent (79-30%) HP:0001824
14 generalized muscle weakness 58 31 frequent (33%) Frequent (79-30%) HP:0003324
15 poor appetite 58 31 frequent (33%) Frequent (79-30%) HP:0004396
16 muscle spasm 58 31 frequent (33%) Frequent (79-30%) HP:0003394
17 episodic abdominal pain 58 31 frequent (33%) Frequent (79-30%) HP:0002574
18 normochromic anemia 58 31 frequent (33%) Frequent (79-30%) HP:0001895
19 ascites 58 31 occasional (7.5%) Occasional (29-5%) HP:0001541
20 intrahepatic cholestasis 58 31 occasional (7.5%) Occasional (29-5%) HP:0001406
21 extrahepatic cholestasis 58 31 occasional (7.5%) Occasional (29-5%) HP:0012334
22 intermittent jaundice 58 31 occasional (7.5%) Occasional (29-5%) HP:0001046
23 abnormal gastrointestinal motility 58 31 occasional (7.5%) Occasional (29-5%) HP:0030895
24 increased circulating gonadotropin level 58 31 very rare (1%) Very rare (<4-1%) HP:0000837
25 respiratory insufficiency due to muscle weakness 58 31 very rare (1%) Very rare (<4-1%) HP:0002747
26 follicular thyroid carcinoma 58 31 very rare (1%) Very rare (<4-1%) HP:0006731
27 growth hormone excess 58 31 very rare (1%) Very rare (<4-1%) HP:0000845
28 neoplasm of the liver 58 31 very rare (1%) Very rare (<4-1%) HP:0002896
29 ganglioneuroma 58 31 very rare (1%) Very rare (<4-1%) HP:0003005
30 subcutaneous lipoma 58 31 very rare (1%) Very rare (<4-1%) HP:0001031
31 parathyroid adenoma 58 31 very rare (1%) Very rare (<4-1%) HP:0002897
32 adrenocortical adenoma 58 31 very rare (1%) Very rare (<4-1%) HP:0008256
33 pituitary adenoma 58 31 very rare (1%) Very rare (<4-1%) HP:0002893
34 primary hyperparathyroidism 58 31 very rare (1%) Very rare (<4-1%) HP:0008200
35 elevated calcitonin 58 31 very rare (1%) Very rare (<4-1%) HP:0003528
36 increased circulating prolactin concentration 58 31 very rare (1%) Very rare (<4-1%) HP:0000870
37 benign gastrointestinal tract tumors 58 31 very rare (1%) Very rare (<4-1%) HP:0006719
38 increased circulating cortisol level 31 very rare (1%) HP:0003118
39 hematochezia 58 Excluded (0%)
40 abnormality of the thyroid gland 58 Very rare (<4-1%)
41 hypercortisolism 58 Very rare (<4-1%)
42 abnormality of abdomen morphology 58 Occasional (29-5%)

UMLS symptoms related to Vipoma:


diarrhea

Drugs & Therapeutics for Vipoma

Drugs for Vipoma (from DrugBank, HMDB, Dgidb, PharmGKB, IUPHAR, NovoSeek, BitterDB):

(show all 29)
# Name Status Phase Clinical Trials Cas Number PubChem Id
1
Gefitinib Approved, Investigational Phase 2 184475-35-2 123631
2
Sorafenib Approved, Investigational Phase 2 284461-73-0 216239 406563
3
Everolimus Approved Phase 2 159351-69-6 6442177 70789204
4
Octreotide Approved, Investigational Phase 2 83150-76-9 383414 6400441
5
Bevacizumab Approved, Investigational Phase 2 216974-75-3
6
Sirolimus Approved, Investigational Phase 2 53123-88-9 5284616 6436030
7 Protein Kinase Inhibitors Phase 2
8 Antineoplastic Agents, Immunological Phase 2
9 Angiogenesis Inhibitors Phase 2
10 Gastrointestinal Agents Phase 2
11 Mitogens Phase 2
12 Immunosuppressive Agents Phase 2
13 Immunoglobulins Phase 2
14 Immunoglobulins, Intravenous Phase 2
15 Immunologic Factors Phase 2
16 Immunoglobulin G Phase 2
17 Antineoplastic Agents, Hormonal Phase 2
18 Endothelial Growth Factors Phase 2
19 Antibodies Phase 2
20 Antibodies, Monoclonal Phase 2
21
Paclitaxel Approved, Vet_approved Phase 1 33069-62-4 36314
22
Trastuzumab Approved, Investigational Phase 1 180288-69-1 9903
23
Carboplatin Approved Phase 1 41575-94-4 10339178 498142 38904
24
Pancrelipase Approved, Investigational Phase 1 53608-75-6
25 Albumin-Bound Paclitaxel Phase 1
26 Adjuvants, Immunologic Phase 1
27 Interleukin-12 Phase 1
28 pancreatin Phase 1
29 Hemostatics Phase 1

Interventional clinical trials:


# Name Status NCT ID Phase Drugs
1 A Phase II Trial of ZD1839 (Iressa®) in Metastatic Neuroendocrine Tumors Completed NCT00075439 Phase 2 gefitinib
2 A Phase II Trial of Bay 43-9006 in Progressive Metastatic Neuroendocrine Tumors Completed NCT00131911 Phase 2 sorafenib tosylate
3 Randomized Phase II Study of Everolimus Alone Versus Everolimus Plus Bevacizumab in Patients With Locally Advanced or Metastatic Pancreatic Neuroendocrine Tumors Active, not recruiting NCT01229943 Phase 2 Everolimus;Octreotide Acetate
4 A Phase I Trial of Herceptin and Interleukin-12 Completed NCT00004074 Phase 1
5 Phase I Feasibility Trial To Study The Safety Of Sealing Resected Pancreatic Surfaces After Partial Distal Pancreatectomy Using Laser Tissue Welding Recruiting NCT03147768 Phase 1
6 A Phase 1 Study of Veliparib (ABT-888) in Combination With Capecitabine and Temozolomide in Advanced Well-Differentiated Neuroendocrine Tumors Withdrawn NCT02831179 Phase 1 Capecitabine;Temozolomide;Veliparib

Search NIH Clinical Center for Vipoma

Cochrane evidence based reviews: vipoma

Genetic Tests for Vipoma

Anatomical Context for Vipoma

MalaCards organs/tissues related to Vipoma:

40
Pituitary, Pancreas, Small Intestine, Thyroid, Liver, Adrenal Gland, Kidney

Publications for Vipoma

Articles related to Vipoma:

(show top 50) (show all 305)
# Title Authors PMID Year
1
VIPoma with expression of both VIP and VPAC1 receptors in a patient with WDHA syndrome. 54 61
19184565 2009
2
VIPomas: an update in diagnosis and management in a series of 11 patients. 61 54
16001675 2005
3
Laparoscopic distal pancreatectomy for neuroendocrine tumors of the pancreas. 54 61
15816491 2005
4
[Jejunal vipoma]. 61 54
15646540 2004
5
Expression of somatostatin receptor and effects of somatostatin analog on pancreatic endocrine tumors. 61 54
12181718 2002
6
Metastatic jejunal VIPoma: beneficial effect of combination therapy with interferon-alpha and 5-fluorouracil. 54 61
10638600 2000
7
Functional pancreatic islet cell tumors with liver metastasis: the role of cytoreductive surgery and transcatheter arterial chemoembolization: a report of five cases. 54 61
9884450 1998
8
Expression of peptide receptors in human endocrine tumours of the pancreas. 61 54
9071943 1997
9
[Metastasizing pancreatic vipoma. Its diagnosis and therapy with the somatostatin analog octreotide]. 54 61
7588006 1995
10
Liver VIPoma: report of two cases and literature review. 54 61
7950821 1994
11
In vitro release of vasoactive intestinal polypeptide and pancreatic polypeptide from human VIPoma cells and its inhibition by somatostatin analogue (SMS 201-995). 54 61
8197564 1994
12
Stimulation of vasoactive intestinal peptide and neurotensin secretion by pentagastrin in a patient with VIPoma syndrome. 61 54
8128360 1994
13
Chromogranin A(210-301) is the major form of pancreastatin-like material in human gut extracts and endocrine tumors. 54 61
7984507 1994
14
Use of octreotide in the treatment of digestive neuroendocrine tumours. Seven year experience in 20 cases including 9 cases of metastatic midgut carcinoid and 5 cases of metastatic gastrinoma. 61 54
8266771 1993
15
Calcitonin, as SMS 201-995, ameliorates the VIPoma syndrome. 61 54
8383153 1993
16
[VIPoma: surgical treatment]. 54 61
1314346 1992
17
[The somatostatin analog SMS 201-995 in long-term treatment of vipoma]. 61 54
2177234 1990
18
Future medical prospects for Sandostatin. 61 54
2205787 1990
19
Future medical prospects for Sandostatin. 54 61
1980778 1990
20
[Vipoma in an adolescent: treatment with a delayed-action somatostatin analog, octreotide or SMS 201-995, and surgical removal]. 61 54
2176428 1990
21
Pancreatoduodenectomy for Neuroendocrine Tumors in Patients with Multiple Endocrine Neoplasia Type 1: An AFCE (Association Francophone de Chirurgie Endocrinienne) and GTE (Groupe d'étude des Tumeurs Endocrines) Study. 61
33649917 2021
22
Pancreatic neuroendocrine tumors: Surgical outcomes and survival analysis. 61
33375953 2021
23
Repurposing calcium-sensing receptor agonist cinacalcet for treatment of CFTR-mediated secretory diarrheas. 61
33400691 2021
24
Percutaneous Cryoablation of Recurrent Pancreatic Mass for Life-Threatening Pancreatic VIPoma Syndrome: A Case Report. 61
32914368 2021
25
Pancreatic neuroendocrine neoplasms: Clinicopathological features and pathological staging. 61
33305819 2020
26
MORPHOLOGICAL DIAGNOSIS OF PANCREATIC NEUROENDOCRINE TUMORS (REVIEW AND CASE REPORT). 61
33395650 2020
27
Vasoactive intestinal peptide-oma causing refractory diarrhea in a young woman. 61
33100555 2020
28
Incidental 68Ga-DOTATATE uptake in the pancreatic head: A case report and a unique opportunity to improve clinical care. 61
32481385 2020
29
Metastatic VIPoma, Cosecreting Insulin, With Complete Response to Lanreotide, Capecitabine, and Temozolomide. 61
32168252 2020
30
A Rare Cause of Refractory Chronic Diarrhea and Cachexia: A Case Report. 61
32461947 2020
31
Neuroendocrine pancreatic tumor causing chronic diarrhea in young adult, a case report. 61
32420536 2020
32
Clinical Characteristics and Management of Functional Pancreatic Neuroendocrine Neoplasms: A Single Institution 20-Year Experience with 286 Patients. 61
33204258 2020
33
Rare Cases of Pediatric Vasoactive Intestinal Peptide Secreting Tumor With Literature Review: A Challenging Etiology of Chronic Diarrhea. 61
32850544 2020
34
[Use of a somatostatin analog to improve a patient's condition and the subsequent diagnosis of pancreatic VIPoma:a case report]. 61
31941861 2020
35
Successful Treatment of Hypokalemic Rhabdomyolysis Caused by a Pancreatic VIPoma: A Case Report. 61
31754090 2019
36
Life-threating diarrhea and acute renal failure secondary to pancreatic VIPoma treated by surgery. 61
31232078 2019
37
Diagnostic and Management Challenges in Vasoactive Intestinal Peptide Secreting Tumors: A Series of 15 Patients. 61
31268974 2019
38
Pancreatic neuroendocrine microadenomatosis presenting as a functional VIPoma. 61
31275551 2019
39
Prevalence of Diagnostic Methods and Treatment Modalities in Vipoma Patients: A Rare Cause of Hormone-Mediated Diarrhea. 61
31641634 2019
40
Symptomatic and Radiological Response to 177Lu-DOTATATE for the Treatment of Functioning Pancreatic Neuroendocrine Tumors. 61
30566620 2019
41
Clinicopathological data and treatment modalities for pancreatic vipomas: a systematic review. 61
31127985 2019
42
Results of Duodenopancreatic Reoperations in Multiple Endocrine Neoplasia Type 1. 61
30288555 2019
43
Perioperative Hypotensive Crisis in an Adolescent with a Pancreatic VIPoma and MEN1-Gene Variant. 61
30326482 2019
44
Chronic Diarrhea Secondary to Newly Diagnosed VIPoma. 61
31123451 2019
45
Pancreatic VIPomas from China: Case reports and literature review. 61
30391116 2019
46
Octreotide reverses shock due to vasoactive intestinal peptide-secreting adrenal pheochromocytoma: A case report and review of literature. 61
30510956 2018
47
[Surgical strategies for small sporadic neuroendocrine pancreatic tumors]. 61
29637243 2018
48
Paediatric VIPoma: A Jamboree of Electrolytes. 61
29744252 2018
49
[VIPoma : a rare etiology of diarrhea with hypokalemia]. 61
29384277 2018
50
[A Surgical Resected Case of VIPoma with Para-Aortic Lymph Node Involvement]. 61
29394839 2017

Variations for Vipoma

Expression for Vipoma

Search GEO for disease gene expression data for Vipoma.

Pathways for Vipoma

GO Terms for Vipoma

Cellular components related to Vipoma according to GeneCards Suite gene sharing:

# Name GO ID Score Top Affiliating Genes
1 extracellular space GO:0005615 9.56 SST SCT PPY GHRH GH1 GAST
2 extracellular region GO:0005576 9.32 VIP SST SCT PPY NTS GHRH

Biological processes related to Vipoma according to GeneCards Suite gene sharing:

(show all 13)
# Name GO ID Score Top Affiliating Genes
1 negative regulation of cell proliferation GO:0008285 9.78 SSTR3 SST SMAD4 MEN1
2 adenylate cyclase-activating G protein-coupled receptor signaling pathway GO:0007189 9.58 VIP GHRH CALCA
3 cell-cell signaling GO:0007267 9.56 SSTR3 SST GHRH CALCA
4 feeding behavior GO:0007631 9.52 PPY CALCA
5 positive regulation of multicellular organism growth GO:0040018 9.51 GHRH GH1
6 positive regulation of transforming growth factor beta receptor signaling pathway GO:0030511 9.49 SMAD4 MEN1
7 response to food GO:0032094 9.46 GHRH GAST
8 positive regulation of blood vessel diameter GO:0097755 9.43 VIP CALCA
9 positive regulation of insulin-like growth factor receptor signaling pathway GO:0043568 9.37 GHRH GH1
10 response to transforming growth factor beta GO:0071559 9.32 SMAD4 MEN1
11 G protein-coupled receptor signaling pathway GO:0007186 9.28 VIP SSTR3 SST SCT PPY NTS
12 neuropeptide signaling pathway GO:0007218 9.26 SSTR3 PPY NTS CALCA
13 hormone-mediated apoptotic signaling pathway GO:0008628 9.16 SSTR3 SST

Molecular functions related to Vipoma according to GeneCards Suite gene sharing:

# Name GO ID Score Top Affiliating Genes
1 R-SMAD binding GO:0070412 9.26 SMAD4 MEN1
2 neuropeptide hormone activity GO:0005184 9.26 VIP PPY NTS GHRH
3 hormone activity GO:0005179 9.23 VIP SST SCT PPY GHRH GH1
4 peptide hormone receptor binding GO:0051428 9.16 VIP GHRH

Sources for Vipoma

3 CDC
7 CNVD
9 Cosmic
10 dbSNP
11 DGIdb
17 EFO
18 ExPASy
19 FMA
20 GARD
28 GO
29 GTR
30 HMDB
31 HPO
32 ICD10
33 ICD10 via Orphanet
34 ICD9CM
35 IUPHAR
36 KEGG
37 LifeMap
39 LOVD
41 MedGen
44 MeSH
45 MESH via Orphanet
46 MGI
49 NCI
50 NCIt
51 NDF-RT
53 NINDS
54 Novoseek
56 OMIM via Orphanet
57 OMIM® (Updated 20-May-2021)
61 PubMed
63 QIAGEN
68 SNOMED-CT via HPO
69 Tocris
70 UMLS
71 UMLS via Orphanet
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