Severe acute pancreatitis due to tamoxifen‐induced hypertriglyceridemia

Yoneyama, Kimiyasu; Nakagawa, Motohito

doi:10.1111/tbj.13279

Cited by 7 publications

(5 citation statements)

References 7 publications

(13 reference statements)

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“…The possible presence of hereditary dyslipidemia remains a factor in the marked exacerbation of hypertriglyceridemia with tamoxifen treatment. In this case, the onset of hypertriglyceridemia-induced acute pancreatitis due to tamoxifen therapy was not confirmed, but previous reports have revealed that tamoxifen increases serum triglyceride level and triggers hypertriglyceridemia-induced acute pancreatitis, whereas its incidence is rare [11]. Marked hypertriglyceridemia is an uncommon but well-established etiology of acute pancreatitis, with a reported incidence of 2-4% [14][15][16].…”

Section: Discussionmentioning

confidence: 75%

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A case of tamoxifen-induced hypertriglyceridemia monitoring the changes in lipoprotein fractions over time

et al. 2021

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Background Tamoxifen, which is one of the selective estrogen receptor modulators (SERMs), can bring out life-threatening complication, e.g. hypertriglyceridemia-induced acute pancreatitis, although it is rare. We precisely report changes in lipoprotein metabolism before and after tamoxifen discontinuation because there have been few reports of it. Case presentation 47-year-old premenopausal woman with dyslipidemia, type 2 diabetes, nonalcoholic fatty liver disease and chronic kidney disease was prescribed tamoxifen as adjuvant therapy after operation of breast cancer. She experienced severe tamoxifen-induced hypertriglyceridemia several months after dosing tamoxifen. Before cessation of tamoxifen, lipoprotein fraction test revealed marked stagnation of VLDL and IDL metabolisms, resulting in severe hypertriglyceridemia (serum triglyceride level was 1881 mg/dL). Seven days after tamoxifen withdrawal, lipoprotein fraction test showed that the metabolisms of endogenous lipoproteins were changed drastically. Conclusions From these results, we confirmed that tamoxifen certainly changes lipoprotein metabolism through suppression of post-heparin lipolytic activity. It is very important to evaluate the balance between benefit and risk before dosing tamoxifen and survey lipid profiles constantly during treatment to avoid life-threatening complication when prescription of tamoxifen is planned.

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Section: Discussionmentioning

confidence: 75%

“…On the other hand, tamoxifen can bring out life-threatening complication, e.g. hypertriglyceridemia-induced acute pancreatitis, although it is rare [ 11 ]. Therefore, consideration about the balance of potential benefits and risks is required when using tamoxifen for long term.…”

Section: Introductionmentioning

confidence: 99%

A case of tamoxifen-induced hypertriglyceridemia monitoring the changes in lipoprotein fractions over time

et al. 2021

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“…The underlying mechanisms are not fully elucidated but may be related to the ability of tamoxifen to promote liver steatosis [ 161 ]. In addition, tamoxifen treatment is associated with an increased risk of hypertriglyceridemia [ 162 ].…”

Section: Therapeutic Potential Of Estrogen In the Treatment Of Obesitymentioning

confidence: 99%

Estrogens in Adipose Tissue Physiology and Obesity-Related Dysfunction

Kuryłowicz

2023

Biomedicines

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Menopause-related decline in estrogen levels is accompanied by a change in adipose tissue distribution from a gynoid to an android and an increased prevalence of obesity in women. These unfavorable phenomena can be partially restored by hormone replacement therapy, suggesting a significant role for estrogen in the regulation of adipocytes’ function. Indeed, preclinical studies proved the involvement of these hormones in adipose tissue development, metabolism, and inflammatory activity. However, the relationship between estrogen and obesity is bidirectional. On the one hand-their deficiency leads to excessive fat accumulation and impairs adipocyte function, on the other-adipose tissue of obese individuals is characterized by altered expression of estrogen receptors and key enzymes involved in their synthesis. This narrative review aims to summarize the role of estrogen in adipose tissue development, physiology, and in obesity-related dysfunction. Firstly, the estrogen classification, synthesis, and modes of action are presented. Next, their role in regulating adipogenesis and adipose tissue activity in health and the course of obesity is described. Finally, the potential therapeutic applications of estrogen and its derivates in obesity treatment are discussed.

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“…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%

“…We found a total of 17 cases of tamoxifen-induced pancreatitis that fulfilled two of the three Revised Atlanta Classification criteria (Table 3). [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Previous research shows that prolonged tamoxifen therapy is usually required to cause this adverse event. 44 Statistical values from data in these reported cases also support this hypothesis, with a mean onset interval of 11.103 ± 13.098 months.…”

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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Severe acute pancreatitis due to tamoxifen‐induced hypertriglyceridemia

Cited by 7 publications

References 7 publications

A case of tamoxifen-induced hypertriglyceridemia monitoring the changes in lipoprotein fractions over time

A case of tamoxifen-induced hypertriglyceridemia monitoring the changes in lipoprotein fractions over time

Estrogens in Adipose Tissue Physiology and Obesity-Related Dysfunction

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

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