Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: A Case Report and the Literature Review

Abstract

Recurrent acute pancreatitis secondary to hypertriglyceridemia (HTG) with levels below 1000 mg/dL has been rarely reported in the literature. HTG is the third most common cause of acute pancreatitis and has been established in the literature as a risk factor when levels are greater than 1000 mg/dL. A 43-year-old patient presented to the hospital with severe epigastric abdominal pain. Initial laboratory investigations were significant for a lipase level of 4143 U/L and a triglyceride level of 600 mg/dL. Computed tomography (CT) of the abdomen showed diffuse enlargement of the pancreas consistent with pancreatitis. A diagnosis of severe acute pancreatitis secondary to high triglycerides was made based on the revised Atlanta classification 2012. The patient was initially managed with intravenous boluses of normal saline followed by continuous insulin infusion. Diabetic Ketoacidosis (DKA) was ruled out due to a past medical history of diabetes. Her clinical course was complicated by acute respiratory distress syndrome requiring intubation and mechanical ventilation. During the course, she improved symptomatically and was extubated. She was started on nasogastric feeding initially and subsequently switched to oral diet as tolerated. After initial management of HTG with insulin infusion, oral gemfibrozil was started for long-term treatment of HTG. Emerging literature implicates HTG as an independent indicator of poor prognosis in acute pancreatitis (AP). Despite the paucity of data, the risk of developing AP must be considered even at triglyceride levels lower than 1000 mg/dL.

Hypertriglyceridemia triggered acute pancreatitis in pregnancy – diagnostic approach, management and follow-up care

“…Acute pancreatitis and HTG induced acute pancreatitis features in pregnant versus non-pregnant patientsSeverityHTG is an independent indicator of poor prognosis in AP. Elevated serum TG independently and proportionally correlate with persistent organ failure in AP patients, regardless of etiology[61].…”

Recurrent seasonal severe hypertriglyceridemia-induced acute pancreatitis; a case report

“…Some studies have tried to detect minimum and peak values of serum TG levels according to seasonal variation; however, these studies have yielded contradicting results [ 10 ]. Most cases of recurrent HTG-AP found in the literature are not annual and have occurred randomly throughout the years, and no association between the reoccurrence and the seasons has been pointed out [ 5 , 9 , 18 , 19 ]. The case in the current study is associated with recurrent HTG-AP that occurred annually for the last three years in winter-autumn.…”

“…Hypertriglyceridemia (HTG), which is denoted for high levels of triglycerides (TG) in the blood, is considered an established but still rare cause of AP, accounting for only 1–4% of the cases. However, the association between the two conditions is yet to be completely understood [ 5 , 6 ]. Amongst the mentioned etiologies, HTG-induced AP (HTG-AP) is reported to result in the most severe form of AP, increased risk of complications, and a higher mortality rate.…”

A Case of Recurrent Acute Pancreatitis Secondary to Hypertriglyceridemia

“…Acute pancreatitis is a common gastrointestinal cause of hospitalization in the United States [ 1 ]. It involves the sudden onset of inflammation of the pancreas, which presents with symptoms, including abdominal pain radiating to the back, nausea, vomiting, and/or fever [ 2 ].…”

“…While acute pancreatitis has many causative factors, hypertriglyceridemia is the third most common etiology after gallstones and alcohol abuse. Hypertriglyceridemia is defined as serum triglyceride concentration above 150 mg/dL; triglyceride levels over 1,000 mg/dL are classically regarded as a risk factor for acute pancreatitis [ 1 ]. Around 5% of the patients with serum triglyceride levels above 1,000 mg/dL develop acute pancreatitis, while the incidence of acute pancreatitis is much higher (10%-20%) with levels > 2,000 mg/dL [ 3 ].…”