Pancreatoduodenectomy on a Case with Pancreas Cancer and Isolated ACTH Deficiency-A Case Report

A64-year-old man was admitted to our hospital because he lost consciousness as a result of low blood sugar. At the time, CT revealed a cystic lesion in the pancreas head. After he was admitted, examinations revealed isolated ACTH deficiency (IAD) and intraductal adenocarcinoma of the pancreas head. A steroid was prescribed to treat the symptoms of IAD caused by secondary adrenocorticotropic insufficiency. If enough steroid is not given before and after the operation, patients would easily develop acute adrenal failure. Therefore, we performed pancreatoduodenectomy giving the appropriate amount of steroid. To determine this amount of steroid, we monitored the bloodsugar and Na levels. Three hundred milligrams of hydrocortisone was administered immediately following surgery until post-operative day 2. Beginning on day 3, the amount of hydrocortisone was gradually reduced. As a result, the levels of blood sugar and serum Na were improved. Careful treatment with the steroid resulted in successful PD without any complications. Recently, reports about IAD have been increasing. However, only 4 cases of surgical treatment for those patients have been reported in ourcountry. Criteria of before and after operative treatment for IAD patients have not been established.