Acute Pancreatitis Caused by Tamoxifen-Induced Severe Hypertriglyceridemia After 4 Years of Tamoxifen Use

Tey, Tze Tong; Maung, Aye Chan; Lim, Kim Wei; Hsiang, John

doi:10.14309/crj.0000000000000025

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…However, its lipoprotective effect is limited to lowering serum cholesterol (TC) levels and ultra-low-density lipoprotein (LDL-C) levels but can significantly increase serum triglyceride (TG) levels ( 15 ). Some authors suggest that after tamoxifen-induced hyperlipidemic pancreatitis, letrozole can be replaced to complete subsequent endocrine therapy ( 16 , 17 ). However, numerous publications suggest that nonsteroidal aromatase inhibitors such as letrozole can induce severe dyslipidemia (hypercholesterolemia) and should be closely monitored during clinical use ( 14 , 15 , 18 ).…”

Section: Discussionmentioning

confidence: 99%

Severe hyperlipidemia pancreatitis induced by taking tamoxifen after breast cancer surgery—Case report

Zhai

Xiao

et al. 2023

Front. Oncol.

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IntroductionThe research investigates the mechanism, diagnosis, treatment, and subsequent endocrine therapy of severe pancreatitis induced by tamoxifen treatment in patients who have undergone breast cancer surgery.Case presentationWe studied two cases of breast cancer in whom severe acute pancreatitis developed after taking tamoxifen for endocrine therapy in our hospital. A brief literature review was provided to analyze the causes, clinical manifestations, treatment process, and prognosis of severe acute pancreatitis. Both cases involved patients with severe hyperlipidemic pancreatitis. After conservative treatment, none of them died. Pancreatitis did not recur after changing endocrine therapy drugs.Discussion/conclusionEndocrine therapy with tamoxifen in breast cancer patients can induce hyperlipidemia, which can subsequently cause severe pancreatitis. The treatment of severe pancreatitis should strengthen the regulation of blood lipids. The application of low-molecular-weight heparin combined with insulin therapy can rapidly lower blood lipids. Involved treatments, including acid suppression, enzyme suppression, and peritoneal dialysis, can accelerate the recovery of pancreatitis and reduce the occurrence of serious complications. Patients with severe pancreatitis should not continue to use tamoxifen for endocrine therapy. To complete follow-up endocrine therapy, switching to a steroidal aromatase inhibitor is better if the situation allows it.

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Section: Discussionmentioning

confidence: 99%

Severe hyperlipidemia pancreatitis induced by taking tamoxifen after breast cancer surgery—Case report

Zhai

Xiao

et al. 2023

Front. Oncol.

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“…Several reported cases of tamoxifen-induced hypertriglyceridemic pancreatitis either had a history of dyslipidemia or a metabolic abnormality such as diabetes mellitus. [28][29][30][33][34][35]42 All alternative causes of acute pancreatitis were excluded and drug-induced pancreatitis was diagnosed. One of her medications was venlafaxine.…”

Section: Discussionmentioning

confidence: 99%

“…50 In our literature review, most of the patients had a favorable outcome even with moderate-to-severe pancreatitis. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] However, one patient died after multiorgan failure as a sequela to tamoxifen-induced hypertriglyceridemic pancreatitis. 27 This clinical outcome may add further evidence to the notion that hypertriglyceridemic pancreatitis can follow a devastating disease course such as necrotic pancreatitis, organ failure, and death.…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis secondary to tamoxifen-associated hypertriglyceridemia: A clinical update

Goraya

Abbasi

Amin

et al. 2022

J Oncol Pharm Pract

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Introduction Drug-induced pancreatitis has been increasingly recognized, but it is frequently encountered as an inconspicuous etiology. The underlying mechanisms of injury vary with different drugs. Tamoxifen is a frequently used anticancer drug that acts by selective modulation of the estrogen receptor in patients with breast cancer. Tamoxifen-induced hypertriglyceridemia is a relatively rare etiological factor for acute pancreatitis. However, acute pancreatitis secondary to this adverse effect remains an exceedingly important clinicopathologic entity. Case report We hereby delineate a rare case of acute pancreatitis secondary to hypertriglyceridemia in a patient who was on tamoxifen treatment for the past 3 years. Her serum lipase and triglyceride levels were markedly elevated at 14,285 IU/L and 20,344 mg/dL, respectively. The diagnosis was considered based on the findings of a standard diagnostic workup and exclusion of alternative causes of acute pancreatitis. Management and outcome The patient was instituted prompt treatment with intravenous insulin infusion and gemfibrozil. The clinical outcome was favorable with no complications. Tamoxifen was permanently discontinued and was replaced with letrozole. Discussion This article illustrates that acute pancreatitis should be considered in the differential diagnoses of abdominal pain and elevated pancreatic enzymes in patients undergoing tamoxifen treatment. It also underscores the importance of pre- and post-tamoxifen lipid screening, especially in patients with a history of dyslipidemia and diabetes mellitus. It will facilitate an expedient detection of hypertriglyceridemia, potentially saving patients from associated morbidity and mortality.

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“…Given the widespread use of estrogenic compounds in women and in transsexual men and the prevalence of mild to moderate HTG in the population at risk, individuals with baseline HTG should be identified when using these agents. Among estrogen receptor modulators, tamoxifen used in the management of breast cancer as well as clomiphene, used for infertility have both been reported to cause severe HTG and pancreatitis (80,81), while raloxifene has minimal effects in normotriglyceridemic women (82), but may cause severe HTG in women with a history of estrogen-induced HTG (83). Importantly estrogen therapy is often not discontinued by clinicians in women with a history of HTG-induced pancreatitis (84).…”

Section: Estrogen Estrogen Receptor Agonists and Pregnancymentioning

confidence: 99%

A Comprehensive Update on the Chylomicronemia Syndrome

Goldberg

Chait

2020

Front. Endocrinol.

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The chylomicronemia syndrome is characterized by severe hypertriglyceridemia and fasting chylomicronemia and predisposes affected individuals to acute pancreatitis. When due to very rare monogenic mutations in the genes encoding the enzyme, lipoprotein lipase, or its regulators, APOC2, APOA5, GPIHBP1, and LMF1, it is referred to as the familial chylomicronemia syndrome. Much more frequently, the chylomicronemia syndrome results from a cluster of minor genetic variants causing polygenic hypertriglyceridemia, which is exacerbated by conditions or medications which increase triglyceride levels beyond the saturation point of triglyceride removal systems. This situation is termed the multifactorial chylomicronemia syndrome. These aggravating factors include common conditions such as uncontrolled diabetes, overweight and obesity, alcohol excess, chronic kidney disease and pregnancy and several medications, including diuretics, non-selective beta blockers, estrogenic compounds, corticosteroids, protease inhibitors, immunosuppressives, antipsychotics, antidepressants, retinoids, L-asparaginase, and propofol. A third uncommon cause of the chylomicronemia syndrome is familial forms of partial lipodystrophy. Development of pancreatitis is the most feared complication of the chylomicronemia syndrome, but the risk of cardiovascular disease as well as non-alcoholic steatohepatitis is also increased. Treatment consists of dietary fat restriction and weight reduction combined with the use of triglyceride lowering medications such as fibrates, omega 3 fatty acids and niacin. Effective management of aggravating factors such as improving diabetes control, discontinuing alcohol and replacing or reducing the dose of medications that raise triglyceride levels is essential. Importantly, many if not most cases of the chylomicronemia syndrome can be prevented by effective identification of polygenic hypertriglyceridemia in people with conditions that increase its likelihood or before starting medications that may increase triglyceride levels. Several new pharmacotherapeutic agents are being tested that are likely to considerably improve treatment of hypertriglyceridemia in people at risk.

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Acute Pancreatitis Caused by Tamoxifen-Induced Severe Hypertriglyceridemia After 4 Years of Tamoxifen Use

Cited by 8 publications

References 19 publications

Severe hyperlipidemia pancreatitis induced by taking tamoxifen after breast cancer surgery—Case report

Severe hyperlipidemia pancreatitis induced by taking tamoxifen after breast cancer surgery—Case report

Acute pancreatitis secondary to tamoxifen-associated hypertriglyceridemia: A clinical update

A Comprehensive Update on the Chylomicronemia Syndrome

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