[A Case of Anterior Pituitary Hypofunction and Central Diabetes Insipidus That Occurred after the Extended Right Hepatectomy for Cystic Duct Cancer].

We report a case of anterior pituitary hypofunction and central diabetes insipidus after extended right hepatectomy for cystic duct cancer. A 77-year-old male was admitted to our hospital because of abdominal fullness and anorexia. Cholangiocarcinoma of the hepatic hilum was suspected on CT, and extended right hepatectomy and extrahepatic bile duct resection were performed after portal vein embolization. The pathological diagnosis was cystic duct cancer. Six months after the operation, he suffered from vomit frequently and was admitted, however CT and esophagogastroduodenoscopy showed no gastrointestinal obstruction. The vomiting improved spontaneously and he was discharged, but the next day the vomiting recurred and he was readmitted. Brain and pituitary magnetic resonance imaging(MRI)showed swelling of the pituitary gland, and hypophysitis was suspected. Polyuria also appeared at the same time. Various hormone level measurement revealed anterior pituitary hypofunction and central diabetes insipidus. Hormone replacement therapy and DDAVP nasal spray were started, and symptoms of vomiting and polyuria improved. Hypophysitis causes a decrease in hormone secretion ability in the area of inflammation, and in this case, vomiting occurred due to secondary adrenal insufficiency caused by anterior pituitary hypofunction, and polyuria occurred due to posterior pituitary dysfunction. When there is no gastrointestinal obstruction cause of vomiting, it is important to consider the possibility of hypophysitis and conduct appropriate examination and treatment.