Endocrine Abstracts

Case report: 21-year-old female patient visited the emergency department with repeated attacks of vomiting accompanied with continuous non radiating epigastric pain diagnosed as acute pancreatitis. She had three plasmapheresis sessions. She gave history of recurrent similar attacks for the last 5 years with frequent hospitalization she is known diabetic since the age of 15.Hypertensive for 1 year. Menarche at age of 14 with only one cycle. Upon admission, the patient was alert, Weight: 60 kg, height: 164 cm. BMI: 22 pulse: 90 beat/minute blood pressure: 130/70 respiratory rate: 14/min. Temperature: 37°C. Physical examination: eruptive xanthoma on the extensor surface of the forearms and back. Cardiac examination: apex localized in the left fifth space outside MCL, hyper dynamic. Hepatomegaly two fingers below RT costal, normal fundus, normal neurological examination Breast: Tanner 3, Pubic hair: Tanner 4 Laboratory investigations; RBS 375 mg/dl HBA1C: 14.7%, ABG (PH: 7.38 HCO3: 26 Mm/l SaO2 98.0%) CBC HB;11.6 g/dl, TLC: 5.800/ul PLT:245,000/ul/CRP: 132 mg/dl/Chol: 464 mg/dl, LDL: 257 mg/dl, HDL: 25 mg/dl, TG: 9068 mg/dl amylase: 1120 U/l, Lipase: 370 U/l/Na: 141 mEq/l, K: 3.8 mEq/l, Urea: 34 mg/dl Creatinine: 5 mg/dl, 24 h. Urinary PTN: 1.146 g. ALT: 17 IU/l, AST: 19IU/l,Bil T: 0.9 mg/dl, albumin: 4 g/dl FSH: 0.1, LH:0.5, Estradiol:5, TSH:1.7, FT4:1, ACTH:12, Cortisol AM:8, GH:0.1 ng/ml. Abdominopelvic sonar showed: Enlarged Bright hepatomegaly 16 cms, Mild splenomegaly. Diffuse enlarged pancreas of hypo echoic pattern, picture suggestive of acute pancreatitis. Enlarged swollen kidneys (RT kidney 154*48 mm, LT kidney 152*75 mm.) CT abdomen with contrast: diffusely enlarged pancreatic head. X-ray both arms: Bilateral distal humorous multiloculate bubbly lesion with sclerotic margin. Echocardiography: Concentric LT ventricular hypertrophy. MRI brain (Bulky pituitary gland showing a focal central bulge (0.4×1×0.7). Renal biopsy: Minimal change glomerulonephritis. After three plasmapheresis sessions, Intravenous insulin a marked reduction in triglyceride/total cholesterol levels was observed. CHOL 334 mg/dl, LDL 190 mg/dl, HDL 48 mg/dl, TG 880 mg/dl. She was discharged on dietary, lifestyle modifications and fenofibrates 4 month later she came for follow up Marked improvement of her xanthomata, regular cycles, TG 627mg/dl, HbA1c:8.9, normal pituitary imaging, no organomegaly.

Conclusion: Patients with severe hypertricylcerideamia require fast and effective lowering of TG levels in order to reverse the lipotoxic effect on different organs