Endocrine Abstracts

Introduction: Acute pancreatitis is an inflammatory disease of the pancreas that can lead to necrosis of the pancreas and if infected could lead to multi-organ failure. Common cause of acute pancreatitis are gallstones and excess alcohol consumption. Hypertriglyceridemia is becoming an increasing cause of acute pancreatitis and is diagnosed with serum triglyceride levels >1.7 mmol/l. It is associated with high morbidity and mortality.

Case presentation: 38-year-old male was admitted with left upper quadrant abdominal pain radiating to the back and vomiting. He was haemodynamically stable but was tachycardiac and pyrexic. Past medical history of Diabetes Mellitus type2 on gliclazide and metformin, hypercholesteremia and hypertriglyceridemia on atorvastatin. However, he was not compliant with medication. He would on occasions consume alcohol in excess.

Investigations: Blood test showed raised inflammatory markers, WBC 15.2, CRP 220. Serum triglycerides were elevated 28.77 (normal limit<2.26 mmol/l). Hyperglycaemia with blood glucose level of 17 and HbA1c 111. Amylase was raised at 378. The patient underwent CT Abdomen and Pelvis showing acute pancreatitis. No features of pancreatic necrosis or pseudocyst formation.

Management: Patient was initially managed conservatively with insulin sliding scale, intravenous fluids, analgesia and pabrinex. Started on Atorvastatin 80 mg and Fenofibrate 200 mg.

Discussion: Hypertriglyceridemia is a common form of dyslipidaemia that carries a high risk of cardiovascular disease such as atherosclerosis and hypertension. Hypertriglyceridemia results from environmental and genetic factors and is associated with other conditions such as obesity, diabetes mellitus, hypothyroidism and excess alcohol consumption. Chylomicrons are triglyceride-rich lipoprotein particles that are present when triglyceride are >10 mmol/l and could occlude the pancreatic capillaries leading to ischaemia and enhanced lipolysis leading to release of free fatty acids, inflammatory mediators and free radicals that lead to inflammation, oedema or necrosis of pancreas. Hypertriglyceridemia induced acute pancreatitis associated with high morbidity and mortality risk and may lead to multi-organ failure. It is important to check lipid profile when a patient presents with acute pancreatitis. This can be managed with lifestyle changes and medications such as fenofibrate to help lower serum triglyceride levels below 4.5 mmol/l.

Conclusion: Hypertriglyceridemia is increasingly becoming a cause of acute pancreatitis which carries a high morbidity and mortality risk. It is important to consider this in patients presenting with acute pancreatitis and lipid profile should be requested as initial work-up. This could provide the opportunity to early diagnose hypertriglyceridemia and start treatment earlier to help prevent complications of pancreatitis and further episodes in the future.