Endocrine Abstracts

Introduction: Hypertriglyceridemia is rare but associated cause of pancreatitis and accounts for 10% of cases. Hypertriglyceridemia induced pancreatitis may occur secondary to causes such as diabetes, pregnancy, hypothyroidism and obesity. Management of hypertriglyceridemia includes a change in dietary intake as well as lipid lowering agents, fenofibrates, statins and omega 3 fatty acids. To reduce the triglycerides acutely, intravenous heparin and insulin have been used. In the case reported, the use of intravenous insulin and heparin showed an 80% reduction in triglyceride levels correlating with a significant improvement in clinical symptoms.

Case: A 51-year-old gentleman who was visiting North Wales was admitted under the surgeons with a 1 day history of epigastric pain radiating to the back. His past medical history included hypertension, non-insulin dependent diabetes and previous pancreatitis. Admission bloods revealed a crp 287 mg/l, amylase 893 U/l, cholesterol 20.5 nmol/l, triglycerides of 87.2 nmol/l and a HbA1c 81. His CT showed pancreatic oedema and fat stranding suggestive of acute pancreatitis. Following this, an abdominal ultrasound showed no evidence of gallstones. There was no family history of hyperlipidaemia and he was teetotal excluding these causes, making hypertriglyceridemia the likely diagnosis. He was commenced on fenofibrate, Omega 3 and atorvastatin. Due to his clinical symptoms and the elevated levels of triglyceride, intravenous insulin with 10% dextrose and heparin infusion 0.6 ml/h was started. Within 24 h, the triglyceride level had reduced to 25.8 nmol/l. His pain improved and his was discharged on subcutaneous Lantus and Novorapid.

Conclusion: Hypertriglyceridemia is often associated with poorly controlled diabetes mellitus and can precipitate an acute pancreatitis. The use of intravenous heparin and insulin stimulates lipoprotein lipase activity and chylomicron breakdown, reducing triglyceride levels. Long-term treatment includes dietary modifications, statins and better control of diabetes.