Patient Background
A 52-year-old woman was presented to the emergency department. She had a history of well-controlled hypertension, ischemic heart disease, hyperlipidemia, asthma, and recently diagnosed type 2 diabetes mellitus. She had an unintentional weight loss of 23 kg over two months. She also had polyuria, polydipsia, anorexia, fatigue, and intermittent fever. The family history of the patient included hypertension, thyroid disorders, and gastric cancer.
Clinical Presentation
On admission, the patient had altered mental status and severe abdominal pain. The pain increased after meals and at night. NSAIDs provided temporary relief. She began experiencing progressive abdominal discomfort with systemic symptoms from two months. She was hospitalized for angina and abdominal pain one month earlier. However, she was discharged without resolution.
Emergency Management and Laboratory Findings
She arrived in a state of metabolic decompensation. She had diabetic ketoacidosis (DKA) with hyperglycemia (FBG 439 mg/dL), elevated HbA1c (12.3%), ketonuria, and metabolic acidosis. Inflammatory markers and tumor markers were significantly elevated: CRP was raised, CA19-9 exceeded 10,000 U/mL, and CEA was 365 ng/mL. Vitamin D levels were severely deficient. The patient had normal levels of liver enzymes and bilirubin. Amylase was reduced, and lipase was in the lower reference range.
Imaging and Diagnostic Workup
Abdominopelvic ultrasound showed hepatic lesions suggestive of metastasis and mild hydronephrosis. The patient underwent abdominal contrast-enhanced CT scan that showed a 45 × 40 mm pancreatic body lesion encasing the splenic artery and occluding the splenic vein, alongside multiple hypodense hepatic lesions up to 23 mm in diameter. These findings were consistent with pancreatic adenocarcinoma and liver metastasis.
Diagnosis and Outcome
After DKA stabilization with IV fluids, insulin, and electrolyte replacement, the patient was switched to a basal-bolus insulin regimen. She was referred to endocrinology and gastroenterology specialists. Endoscopic ultrasound-guided fine-needle aspiration confirmed moderately differentiated pancreatic adenocarcinoma with hepatic metastases. The case was referred for oncological evaluation.
