Case Report: Peri-operative management of ACTH-secreting pancreatic neuroendocrine tumor and major vessel reconstruction
Bibliographic record
Abstract
Adrenocorticotrophic hormone (ACTH)-secreting pancreatic-neuroendocrine-tumors are extremely rare. They present a significant peri-operative management challenge because of the tumor’s extensive vascular involvement as well as excess hormone production resulting in electrolyte and metabolic disturbances. A 49-year-old male presented for resection of his ACTH-secreting pancreatic-neuroendocrine-tumor involving the pancreatic head and many major vessels. Pre-operative assessments showed increased serum cortisol, low serum ACTH, negative 24-hour urine 5-hydroxyindoleacetic-acid, and no suppression with 1mg dexamethasone. Pre-operatively, he had ectopic Cushing’s syndrome, type two diabetes mellitus, hypokalemia and thrombocytopenia for which he was treated with insulin, intravenous potassium, and platelets. He was given octreotide at the beginning of surgery. The 10-hour procedure involved both general and vascular surgery. There was eight liters of blood loss and the patient required significant transfusions. At the end of surgery, he remained ventilated due to the duration of surgery and amount of blood loss. Post-operatively, he did well, but he developed adrenal insufficiency secondary to removal of his ACTH-secreting tumor and was discharged home on hydrocortisone. This case highlights the role of anesthesiologists as the peri-operative physician in maintaining homeostasis in these complex patients. It also shows the importance of pre-operative tumor characterization, carcinoid crisis prophylaxis, and a multi-disciplinary approach to the management of these rare tumors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.007 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".