Endocrine Abstracts

Introduction

Tamoxifen is a selective estrogen receptor modulator used in the treatment of estrogen/progesterone receptor-positive breast cancer. Due to the increased frequency of breast cancer in the premenopausal period, the use of tamoxifen is quite common in patients with hormone receptor positivity. Although it is a commonly-used drug, the number of cases with elevated triglyceride levels is very few. Here, we present a case with severe hypertriglyceridemia due to the use of tamoxifen admitting with the acute pancreatitis-like clinic.

The Case

A 44-year-old female patient diagnosed with breast cancer two years ago had undergone neoadjuvant chemotherapy. Tamoxifen treatment was started 1.5 years ago when a positive estrogen receptor has detected a result of pathology. The patient, who presented with complaints of abdominal pain and nausea, was hospitalized with the diagnosis of severe hypertriglyceridemia when the triglyceride level measured was 1560 mg/dl (N 50–150). There was no other disease in the patient’s history that could be the cause of secondary hypertriglyceridemia (diabetes, family history, alcohol use…). Body Mass Index was 26 kg/m². She did not have sensitivity, defense, and rebound in the abdomen in physical examination. Amylase, lipase values, and thyroid function tests were normal in the biochemical examinations of the patient. Since the amylase-lipase values may be normal in pancreatitis with hypertriglyceridemia, abdominal tomography was performed to rule-out possible diagnosis of pancreatitis in the etiology of abdominal pain. In the tomography, the gall bladder, biliary tracts, and pancreas were reported to be normal. Gemfibrozil 1200 mg/day and Omega-3 capsule 3000 mg/day treatment was initiated for the patient. The intravenous fluid replacement was also performed. It was considered that the elevated triglyceride levels of the patient might be due to the use of tamoxifen. After consultation with medical oncology, the patient’s tamoxifen treatment was changed to anastrozole. In the follow-up of the patient, here complaints regressed. The patient, who had triglyceride levels of 480 mg/dl, was discharged.

Conclusion

Clinicians must be careful in terms of hypertriglyceridemia that may be associated with tamoxifen and pancreatitis that may develop in this respect. Screening for dyslipidemia before starting tamoxifen is recommended, especially in people with a family history. Patients’ lipid levels should be followed. In the presence of symptoms, the drug should be discontinued and not retried because of the risk of inducing acute pancreatitis. Even if the amylase and lipase values are normal, caution should be exercised in patients with high triglyceride levels.