Inappropriate Secretion of Antidiuretic Hormone after Pancreatoduodenectomy for Pancreatic Head Cancer: A Case Report and Literature Review

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a disease that leads to dilute hyponatremia through excessive secretion of antidiuretic hormone. SIADH has various causes, including ectopic ADH-producing tumors, drug properties, and can be idiopathic. But there have been very few reports of cases in which SIADH has developed after surgery for malignant tumors. In addition, few cases have been reported where this disease has developed after surgery for pancreatic cancer, because the symptoms of hyponatremia are non-specific. These symptoms are particularly gastrointestinal symptoms; therefore, it is difficult to differentiate them, even if SIADH has developed after gastrointestinal surgery. The patient in our case was an 80-year-old woman. She had persistent epigastralgia and left back pain. Imaging studies revealed a tumor in the head of the pancreas, which was diagnosed as pancreatic head cancer. We performed subtotal stomach-preserving pancreatoduodenectomy. After the operation, she complained of appetite loss and general fatigue. Her serum sodium levels decreased to 109 mEq/L on postoperative day 11. She was diagnosed with SIADH using the SIADH diagnostic criteria listed by the Japanese Ministry of Health, Labor and Welfare. We treated the patient with sodium supplementation for hyponatremia, and her symptoms ameliorated. After the event, she did not relapse with hyponatremia. This case is significant in that we performed differential diagnosis after major gastrointestinal surgery for pancreatic cancer and diagnosed SIADH at an early stage.

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Current approaches to surgical treatment of pancreatic head cancer

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov48485 ◽

2021 ◽

Vol 12 (4) ◽

pp. 5-13

Author(s):

Maxim Yu. Kabanov ◽

Nikolay I. Glushkov ◽

Konstantin V. Sementsov ◽

Anatoliy V. Skorodumov ◽

Valentin V. Alekseev ◽

...

Keyword(s):

Pancreatic Cancer ◽

Surgical Intervention ◽

Malignant Tumors ◽

Pancreatic Head ◽

Malignant Neoplasms ◽

Extensive Experience ◽

Head Cancer ◽

Main Method ◽

Pancreatic Head Cancer ◽

The Past

Pancreatic cancer accounts for 810% of all cases of malignant tumors of the digestive organs and 5060% of pancreaticoduodenal malignant neoplasms. Over the past 30 years the incidence of pancreatic cancer in Russia has increased by 30%. The main method of treatment this category of patients requires surgical intervention. Extensive experience has been gained in using various types of surgical therapy. The review analyzes the results of modern studies on the efficacy and safety of the most common of them.

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A Case of Syndrome of Inappropriate Secretion of Antidiuretic Hormone Complicated after Surgery for Pancreatic Head Cancer

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.42.522 ◽

2009 ◽

Vol 42 (5) ◽

pp. 522-527

Author(s):

Yuuki Takeuchi ◽

Tomoki Fukuoka ◽

Hideki Takami ◽

Hiroki Murakami ◽

Takaya Miwa

Keyword(s):

Antidiuretic Hormone ◽

Pancreatic Head ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Inappropriate Secretion

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Should a standard lymphadenectomy during pancreatoduodenectomy exclude para-aortic lymph nodes for all cases of resectable pancreatic head cancer? A consensus statement by the Chinese Study Group for Pancreatic Cancer (CSPAC)

International Journal of Oncology ◽

10.3892/ijo.2015.3128 ◽

2015 ◽

Vol 47 (4) ◽

pp. 1512-1516 ◽

Cited By ~ 5

Author(s):

CHEN LIU ◽

RUFU CHEN ◽

YINGTAI CHEN ◽

DELIANG FU ◽

DEFEI HONG ◽

...

Keyword(s):

Pancreatic Cancer ◽

Lymph Nodes ◽

Consensus Statement ◽

Pancreatic Head ◽

Study Group ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Chinese Study

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Lethal Bleeding from a Duodenal Cancerous Ulcer Communicating with the Superior Mesenteric Artery in a Patient with Pancreatic Head Cancer

Case Reports in Gastroenterology ◽

10.1159/000492207 ◽

2018 ◽

Vol 12 (2) ◽

pp. 479-486

Author(s):

Yoshifumi Morita ◽

Takanori Sakaguchi ◽

Ryo Kitajima ◽

Satoru Furuhashi ◽

Ryota Kiuchi ◽

...

Keyword(s):

Pancreatic Cancer ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Pancreatic Head ◽

Severe Bleeding ◽

Main Trunk ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Aortic Balloon Occlusion ◽

Duodenal Bleeding

Pancreatic cancer often invades the duodenum and causes obstruction, but rarely causes massive duodenal bleeding. A 68-year-old male was admitted to our hospital because of vomiting. Enhanced abdominal CT showed a hypovascular tumor with air bubbles in the uncinate process of the pancreas. The tumor invaded the duodenum and metastasized to the liver and peritoneum. The main trunk of the superior mesenteric artery (SMA) was circumferentially involved. After admission, he had hematemesis and melena. Emergency gastroduodenoscopy revealed pulsating vessels in the third portion of the duodenum and he eventually experienced hemorrhagic shock. Severe bleeding occurred from his mouth and anus like a catastrophic flood. It was difficult to sustain blood pressure even with massive blood transfusion with pumping. After insertion of an intra-aortic balloon occlusion catheter, the massive bleeding was eventually stopped. Although we attempted interventional radiography, aortography revealed direct communication between the main SMA trunk and the duodenal lumen. The tumor was considered anatomically and oncologically unresectable. Thus, we did not perform further intervention. The patient died 2 h after angiography. Herein, we report the case of pancreatic head cancer causing lethal bleeding associated with tumor-involved SMA. Duodenal bleeding associated with pancreatic cancer invasion should be considered as an oncogenic emergency.

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Urokinase secretion by gastrointestinal adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15529 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15529-e15529

Author(s):

Larisa S. Kozlova ◽

Oleg I. Kit ◽

Elena M. Frantsiyants ◽

Yuriy A. Gevorkyan ◽

Andrey A. Maslov ◽

...

Keyword(s):

Comparative Analysis ◽

Statistical Analysis ◽

Plasminogen Activator ◽

Sigmoid Colon ◽

Malignant Tumors ◽

Pancreatic Head ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Resection Line ◽

Colon And Rectum

e15529 Background: The serine protease urokinase plasminogen activator (uPA) plays an important role in growth and invasion of malignant tumors. The purpose of the study was a comparative analysis of uPA activity (uPA-act) and its antigen (uPA-Ag) content in adenocarcinoma (A) of the esophagus (EA), stomach (SA), pancreatic head (PHA), sigmoid colon (SCA) and rectum (RA). Methods: Tissues of A, perifocal tissues (PT) and resection line tissues were studied by ELISA in 144 patients (39-73 years) with EA (n = 12, G2, T2-3N0-1M0), SA (n = 28, G2, T2-3N0-1M0), PHA (n = 46, G2, Т2-4N0M0), SCA (n = 31, G2, T2-3N0-1M0) and RA (n = 26, G2,T2-3N0-1M0). Statistical analysis was performed using the Statistica 10 program. Results: The levels of uPA-Ag in gastrointestinal A decreased from SA to PHA: SA˃RA˃SCA˃EA˃PHA (p < 0.01). The uPA-Ag levels in A were higher than in the resection line in all cases (p < 0.01). PT levels of uPA-Ag decreased from SA to PHA: SA˃SCA˃RA˃EA˃PHA (p < 0.01). In EA and PHA, PT levels of uPA-Ag were lower than in resection line tissues (p < 0.01), while in SA, SCA and RA they were higher (p < 0.01). Levels of uPA-act were similar in SA and SCA, while in EA and RA they were 1.2 (p = 0.4324) and 1.3 (p = 0.4012) times lower, and in PHA – 40.0-52.5 times lower (p < 0.01) compared to all A samples. The uPA-act in PT was the highest in SCA; 1.4 times lower in SA and RA; 1.7 times lower in EA; 30.9 times lower in PHA. The levels in PT were higher than in the resection line in all cases (p < 0.01). The resection line tissues in EA showed the maximal uPA-Ag content, while their uPA-act was similar to that in other tumors. Levels of uPA-Ag and uPA-act in resection line tissues in other tumors varied but were comparable. Estimated uPA-Ag/uPA-act coefficients in the resection line in SCA and RA were 20.4 and 29.5, respectively; in EA and PHA – 102.0 and 34.8, respectively. Conclusions: Adenocarcinomas of the esophagus, stomach, pancreatic head, sigmoid colon and rectum secrete uPA-Ag and uPA-act into surrounding tissues. The rate of uPA-Ag secretion by the tumor and its activation into uPA-act in pancreatic head cancer differ from that in other tumors.

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