Endocrine Abstracts

Hypertygiceridemia is responsible from the 1–4% of acute pancreatitis cases. When serum triglyceride level rises above 1000–2000 mg/dl, risk of having acute pancreatitis also increases. Medical therapy is usually inadequate for treatment of hypertryglyceridemia cases which cause severe and recurrent pancreatitis attacks. In our case we have reported a patient having recurrent attacks under medical therapy and underwent plasmapheresis.

Case: 45 years old female patient has admitted to the hospital with epigastric pain and had the diagnosis of billiary pancreatitis and underwent cholecystectomy. After that operation she was hospitalized in every 2 or 3 months with severe abdominal pain, detected to have pancreatitis and further investigation was made to explain the reason of recurrent attacks. Severe hypertyglyceridemia was detected in laboratory tests. Although she was receiving fibrate therapy with the maximum tolerable and allowed dosage, her triglyceride levels did not fall below 2000 mg/dl. She was referred to our department in 2011. At the time of hospitalization her TG level was 9000 mg/dl.She underwent plasmapheresis with albumin for once. Her TG level was 600 mg/dl on the first day and 400 mg/dl at the third day after plasmapheresis. It has been 4 months from the plasmapheresis and she did not have any pancreatitis attack. Her triglyceride levels are below 400 mg/dl under fibrate therapy.

Result: Acute pancreatitis occurring secondary to hyperlipidemia is principally treated with hydration and pain palliation. Severe and recurrent attacks can be counted as plasmapheresis indication.Plasmapheresis reduces tryglyceride levels, removes active enzymes and preinflammatory molecules from the circulation. Although there is information about benefits of plasmapheresis for prevention of recurrent pancreatitis in hypertrygiceridemic patients there is no consensus about the ideal frequency and duration of therapy. As we see from our case sometimes only one plasmapheresis might be cost-effective and adequate for secondary prevention.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.