451: A CASE OF DKA AND ACUTE PANCREATITIS IN AN ADOLESCENT FEMALE WITH SEVERE HYPERTRIGLYCERIDEMIA

Supplementary estrogen plays important roles for female patients as convenient birth control, relief of postmenopausal symptoms, and in the management of other selected problems. However, as is the case for essentially all medications, there are side effects. Short of a major pulmonary embolus, the most severe side effect of estrogen would appear to be sporadic, rare, and severe hypertriglyceridemia associated with acute pancreatitis. The occurrence of this fortunately rare problem usually happens in the presence of some preexisting and usually mild increase in triglycerides (TG). A case of chronic and severe recurrent acute pancreatitis is described in the introduction and the management was complete estrogen avoidance. Started close to menopause and continued for a relatively short period, estrogens may have some cardiovascular (CV) benefit but the general recommendation is not to prescribe them for CV disease prevention. Estrogens may contribute to decreased diabetes mellitus (DM) risk and control. Administration of estrogens by the transdermal route may decrease some problems such as venous thromboembolism (VTE) and elevation of TG. Administration of estrogen in the right situation brings significant benefit to the female patient but skillful, careful, and knowledgeable use is essential.

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Familial Chylomicronemia Syndrome-Induced Acute Necrotizing Pancreatitis during Pregnancy

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1722173 ◽

2021 ◽

Vol 43 (03) ◽

pp. 220-224

Author(s):

Julia Cristina Coronado Arroyo ◽

Marcio José Concepción Zavaleta ◽

Eilhart Jorge García Villasante ◽

Mikaela Kcomt Lam ◽

Luis Alberto Concepción Urteaga ◽

...

Keyword(s):

Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Clinical Course ◽

Necrotizing Pancreatitis ◽

Rare Condition ◽

Severe Hypertriglyceridemia ◽

Fetal Complications ◽

Acute Necrotizing ◽

History Of ◽

Important Objective

AbstractAcute pancreatitis is a rare condition in pregnancy, associated with a high mortality rate. Hypertriglyceridemia represents its second most common cause. We present the case of a 38-year-old woman in the 24th week of gestation with a history of hypertriglyceridemia and recurrent episodes of pancreatitis. She was admitted to our hospital with acute pancreatitis due to severe hypertriglyceridemia. She was stabilized and treated with fibrates. Despite her favorable clinical course, she developed a second episode of acute pancreatitis complicated by multi-organ dysfunction and pancreatic necrosis, requiring a necrosectomy. The pregnancy was ended by cesarean section, after which three plasmapheresis sessions were performed. She is currently asymptomatic with stable triglyceride levels. Acute pancreatitis due to hypertriglyceridemia represents a diagnostic and therapeutic challenge in pregnant women, associated with serious maternal and fetal complications. When primary hypertriglyceridemia is suspected, such as familial chylomicronemia syndrome, the most important objective is preventing the onset of pancreatitis.

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Severe Hypertriglyceridemia-Induced Acute Pancreatitis

Case Reports in Gastroenterology ◽

10.1159/000511017 ◽

2021 ◽

pp. 218-224

Author(s):

Gyula Molnár ◽

V. Anna Gyarmathy ◽

Noémi Zádori ◽

Péter Hegyi ◽

Péter Kanizsai

Keyword(s):

Acute Pancreatitis ◽

Acute Abdominal Pain ◽

Blood Cholesterol ◽

Individual Factors ◽

Lipid Levels ◽

Human Monoclonal Antibodies ◽

Pcsk9 Inhibitors ◽

Severe Hypertriglyceridemia ◽

The Right

The prevalence of familial hypercholesterolemia (FH) is about 1 in 200–500 in the general population, but approximately less than 1% of those affected are actually diagnosed. One of the most promising approaches to treat FH is utilizing human monoclonal antibodies. This is a case study describing a 47-year-old male patient who presented to the Emergency Department with acute abdominal pain caused by severe hypertriglyceridemia (HTG)-induced acute pancreatitis (AP). We report the steps necessary for establishing the right diagnosis and the management of HTG-induced AP, which are inevitable for the reduction of severity and mortality. This case study shows that hypercholesterolemia is an underdiagnosed and potentially lethal disease. Once diagnosed, all measures should be considered to control blood cholesterol and lipid levels. The decision to administer PCSK9 inhibitors should not be solely based on economical calculation, but rather individual factors should also be considered to weigh the risk/benefit ratio.

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Case Report: Plasmapheresis as an early treatment for Severe Hypertriglyceridemia, Acute Pancreatitis, and Diabetic Ketoacidosis

AACE Clinical Case Reports ◽

10.1016/j.aace.2021.03.009 ◽

2021 ◽

Author(s):

Ayesha Monga Kravetz ◽

Pooja Sanghavi ◽

Vidit Bhargava ◽

Run Zhang Shi ◽

Laura M. Nally

Keyword(s):

Acute Pancreatitis ◽

Case Report ◽

Diabetic Ketoacidosis ◽

Early Treatment ◽

Severe Hypertriglyceridemia

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Severe Hypertriglyceridemia Possibly Masked Acute Pancreatitis and Led to a Difficult Diagnosis in an Obese Patient with Ketoacidosis-onset Type 2 Diabetes

Internal Medicine ◽

10.2169/internalmedicine.8474-16 ◽

2017 ◽

Vol 56 (19) ◽

pp. 2611-2616 ◽

Cited By ~ 4

Author(s):

Midori Fujishiro ◽

Akiko Horita ◽

Hiroshi Nakagawara ◽

Takayuki Mawatari ◽

Yoshifusa Kishigami ◽

...

Keyword(s):

Type 2 Diabetes ◽

Acute Pancreatitis ◽

Obese Patient ◽

Onset Type ◽

Difficult Diagnosis ◽

Severe Hypertriglyceridemia

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A Case of Acute Pancreatitis and Severe Hypertriglyceridemia Associated with Clozapine

Journal of Korean Endocrine Society ◽

10.3803/jkes.2007.22.5.381 ◽

2007 ◽

Vol 22 (5) ◽

pp. 381

Author(s):

Hye Kyeong Park ◽

Hye Jin Won ◽

Hyo Seung Ahn ◽

Ban Suk Lee ◽

Seung Gu Kim ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Hypertriglyceridemia

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Hypertriglyceridemia, a common dyslipidemia of complex definition

Italian Journal of Medicine ◽

10.4081/itjm.2009.220 ◽

2013 ◽

pp. 220-226

Author(s):

Chiara Trenti ◽

Emanuele A. Negri ◽

Ido Iori ◽

Davide Favali

Keyword(s):

Cardiovascular Disease ◽

Acute Pancreatitis ◽

Genetic Basis ◽

Hepatic Function ◽

Biochemical Finding ◽

Cholesterol Levels ◽

Severe Hypertriglyceridemia ◽

Increased Risk ◽

Very High ◽

Regular Physical Exercise

Background: Hypertriglyceridemia is a common biochemical finding. Depending on the triglyceride levels it can be associated with increased risk of acute pancreatitis and of cardiovascular disease. The most severe forms have a genetic basis. Clinical case: We report a case of a 60-year-old woman with very high triglycerides (800- 3,000 mg/dL) and normal cholesterol levels. The patient is a non smoker, on hypolipemic diet, non alcoholic consumer, and on regular physical exercise. Her blood pressure is normal, BMI is 20, waist circumference is 78 cm. Thyroid, renal and hepatic function are normal. She has never had acute pancreatitis or cardiovascular disease. Discussion: The diagnostic and therapeutic management of this case is discussed. Causes of primary (genetic) and secondary hypertriglyceridemia are also reviewed, together with clinical features and management on every day practice. We focused on severe hypertriglyceridemia.

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