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