Abstract: The aim of this article was to explore the diagnostic approach and treatment of persistent hypotension in postoperative patients with severe acute pancreatitis(SAP). The diagnostic approach and treatment were summarized through retrospectively analyzing the clinical data of one SAP patient with persistent postoperative hypotension. This was a 61 years old male SAP patient and was transferred to the department of critical care medicine after surgery. Hypovolemic shock and infection, the initial features of this patient, were controlled after resuscitation and anti-infective therapy. But the patient still had persistent hypotension. All types of shock were distinguished and hormone examination was performed. The patient was finally diagnosed as critical illness-related corticosteroid insufficiency(CIRCI). The symptom of persistent hypotension was significantly improved after hormone replacement. At the one-month follow-up, the patient's blood pressure returned to normal and then hormone therapy was stopped. The possibility of CIRCI should be taken into account when a SAP patient with unexplained persistent postoperative hypotension after the successful control for infection. Early diagnosis and glucocorticoid replacement therapy is helpful for the recovery of the patients.