Endocrine Abstracts

Acute pancreatitis in kidney transplant recipients is an infrequent complication with complex etiology. However, there was no enough data about chronic pancreatitis after kidney transplantation. Glucose intolerance occurs with some frequency in chronic pancreatitis, but overt diabetes mellitus usually occurs late in the course of the disease. We presented long-term course of a kidney transplant recipient who developed recurrent acute pancreatitis.

Case report: A 43-year-old female patient underwent cholecystectomy due to pancreatitis attack secondary to cholelithiasis on January 2008. She had no history of obesity, dyslipidemia, diabetes and alcohol abuse. She received a successful kidney transplant from a deceased donor in our center on March 2008 because of end-stage kidney disease. Post-transplant immunosuppressive treatment consisted of prednisolone, mycophenolate sodium and everolimus. Gemfibrozil was started 600 mg daily due to her high serum triglyceride level (592 mg/dl) on May 2008. After a week, she was admitted to the emergency service because of abdominal pain, nausea, vomiting, mild dehydration and upper abdominal tenderness. Her tests revealed a serum glucose of 120 mg/dl, total cholesterol 306 mg/dl, triglyceride 323 mg/dl and amylase 746 IU/l. Acute pancreatitis complicated by a pseudocyst was diagnosed and treated. Hyperglycemia that developed during this period was treated with insulin administration. Fenofibrate and pravastatin were started. After sphincterotomy to pancreatic duct and a biliary stent insertion by ERCP, her complaints resolved. Then, the pancreatic biliary stent was removed. In 2009 and 2016, acute pancreatitis recurred due to stones. The head and corpus of pancreas were atrophic. Pancreatic duct was enlarged. In 2013, a 2-h oral glucose tolerance test was performed due to hyperglycemia (fasting glucose 129 mg/dL and 2nd hour glucose 178 mg/dl, HbA1c 6.5%). The patient was started insulin glargin treatment (10 U/d) with a diagnosis of secondary diabetes mellitus. Then, metformin (2×500 mg) was added to the treatment. She went on her follow-ups with a serum creatinine of 0.8 mg/dl (glucose; fasting: 89 mg/dl, postprandial: 108 mg/dl, HbA1c 6.2%, total cholesterol 211 mg/dl, HDL cholesterol 65 mg/dl, LDL cholesterol 110 mg/dl and triglyceride 176 mg/dl) with medical treatment.

Conclusion: Chronic pancreatitis is an inflammatory condition. The clinical manifestations of this disorder include chronic abdominal pain and pancreatic exocrine and endocrine dysfunction leading to secondary diabetes. When needed, these patients should be treated with insulin and oral hypoglycaemic agents.