Endocrine Abstracts

Introduction: Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory skin disease, that is characterised by painful lesions in apocrine gland-bearing areas. Patients also present with significantly increased rates of cardiovascular risk factors, such as dyslipidaemia, diabetes, metabolic syndrome. Adalimumab a fully human IgG1 monoclonal antibody that specifically binds to TNF-α is an established treatment for HS. Combined hormonal contraception is commonly used in general female population. Both medications are known to moderately increase cholesterol and triglycerides (TG).

Case report: We report a case of 34-year-old woman who was admitted to emergency department because of acute abdominal pain. Patient was treated with adalimumab 40 mg QW for previously diagnosed HS and used etonogestrel/ethinylestradiol vaginal ring (VR) for contraception. On admission she complained about sudden onset of nausea and dull abdominal pain, propagating to the back. She denied alcohol abuse. Blood pressure was 140/85 mmHg, height 158 cm, weight 93 kg, body mass index 37.3 kg/m². Abdominal examination revealed generalised tenderness on palpation. Bowel sounds were silent, but present. On admission blood was lipemic and could not be analysed. On abdominal ultrasound liver steatosis was present, cholecystolithiasis and cholecystitis were excluded. Computed tomography of abdomen revealed inflammation of the pancreas and retroperitoneal fat of 10 cm in diameter. We treated her with parenteral hydration, analgesics and plasmapheresis. Results of blood test after initial treatment were: white cell count 15.5×10⁹/l (normal range 4-10×10⁹/l), C-reactive protein (CRP) 135 mg/l (<5 mg/l), amylase 2.22 µkat/l (0.52-1.78 µkat/l), lipase 4.68 µkat/l (<1.07 µkat/l), cholesterol 19.5 mmol/l (<5 mmol/l), TG 49.1 mmol/l (<1.7 mmol/l). Liver function tests were normal. We discontinued treatment with adalimumab and removed VR. During hospitalisation TG level gradually decreased to 8.0 mmol/l, and CRP transiently increased to 368 mg/l and then normalised. No antibiotic treatment was necessary. On follow-up visit additional trend of normalisation of TG was noted.

Discussion and conclusion: To our knowledge this is the first case of hypertriglyceridemia induced pancreatitis, caused by combination of treatment with adalimumab for HS and with VR, without any other predisposing conditions. When combining treatment with known side effects on lipid metabolism, we should consider possible multiplicative effect, especially in patients prone to metabolic complications. Prior to initiating and during treatment regular laboratory test should be performed.