Endocrine Abstracts

Background: Acute pancreatitis is both a medical and surgical emergency. Common causes of acute pancreatitis include gallstones and alcohol. Hypertriglyceridemia-induced pancreatitis is rare (1-4%); here we discuss management of 5 cases of hypertriglyceridemia-induced pancreatitis.

Case-1: 37-year-old female presented to A&E with epigastric pain radiating to back and vomiting. Blood test showed raised amylase, triglyceride 81.6 and cholesterol 6.1. CT-Abdomen showed acute pancreatitis. She was treated conservatively with insulin sliding-scale and intravenous antibiotics. She was discharged on atorvastatin and fenofibrate.

Case-2: 45-year-old male presented with abdominal pain radiating to back. Bloods showed raised triglycerides 43.1 and cholesterol 5.1. CT-Abdomen showed acute-on-chronic pancreatitis. Treated conservatively with insulin sliding-scale and kept nil-by-mouth initially.

Case-3: 28-year-old female presented with acute generalised crampy abdominal pain and vomiting. Medical history included Type2 Diabetes Mellitus and high BMI. Blood test showed raised triglycerides 71.26. CT-Abdomen showed acute pancreatitis. Managed conservatively with an insulin sliding-scale and discharged on atorvastatin and fenofibrate.

Case-4: 42-year-old male was admitted with abdominal pain, diarrhoea and vomiting. Blood showed raised triglycerides 40. CT-Abdomen showed acute pancreatitis. Treated with insulin sliding-scale and analgesia. He clinically improved and discharged with atorvastatin, fenofibrate and lifestyle advice.

Case-5: 38-year-old male was admitted with left-upper-quadrant abdominal pain radiating to back and vomiting. Medical history included Type2 Diabetes Mellitus, hypercholesteremia and hypertriglyceridemia (non-compliant with medication). Blood showed raised amylase 378, triglycerides 28.77 and hyperglycaemia of 17. CT-Abdomen showed acute pancreatitis and treated conservatively with insulin sliding-scale and analgesia. Discharged on atorvastatin, fenofibrate and lifestyle advice.

Discussion: Hypertriglyceridemia is an increasing cause of acute pancreatitis and is associated with high morbidity and mortality risk. Hypertriglyceridemia-induced pancreatitis is caused by the hydrolysis of excessive triglyceride-rich lipoproteins releasing high concentrations of free-fatty-acids that cause inflammation of the pancreas. This case series describes initial management is conservative with insulin infusion, intravenous fluids and analgesia. Plasmapheresis is considered in severe pancreatitis where above measures have failed. Contrast-enhanced CT is important to look at severity, presence of gallstones and necrotizing pancreatitis.

Conclusion: Hypertriglyceridemia-induced acute pancreatitis is a rare but a well-established cause of acute pancreatitis. It is important to check lipid profile when a patient presents with acute pancreatitis as it is often associated with greater clinical severity and rate of complications. Early diagnosis with correct treatment will help prevent complications. It is important to advice on lifestyle changes and start on medications such as fenofibrate to help lower serum triglyceride levels.