Endocrine Abstracts

Introduction: Acute pancreatitis induced by hypertriglyceridemia is a severe condition and its management is complicated.

Case report: We present a case of severe acute pancreatitis induced by hypertriglyceridemia secondary to lipoprotein lipase -LPL- deficiency (188 Gly-Glu mutation, LPL undetectable activity) in a pregnant patient with gestational diabetes.

The patient was sent to our Lipid Unit in the 13th gestation’ week. The triglyceride levels were 5337 mg/dl at the beginning. Our patient was initially managed with diet (very low fat diet and low carbohydrates because of gestational diabetes) and omega-3 supplements but it was necessary to carry out artificial nutricional support: total parenteral nutrition (TPN) because she presented acute pancreatitis secondary to hypertriglyceridemia. We used a omega 3 enriched TPN. Meanwhile the patient was supported with TPN the triglycerides levels were 537 mg/dl (the lowest level in her medical history). She had a healthy female baby.

Conclusions: LPL deficiency might cause severe hypertriglyceridemia, repetition acute pancreatitis which is an unwieldy and severe situation during pregnancy. Acute familial hypertriglyceridemia pancreatitis accounts for 5% of cases, including LPL deficiency.

The goal of treatment is to reach triglycerides levels below 500 mg/dl, being very low fat diet the treatment of choice, drugs or plasmapheresis techniques can also be associated. Clinical guidelines do not recommend to supplement with lipids de TPN composition in pancreatitis induced by hipertrygliceridemia, but we decided to use w3 fatty acids (20% of total kilocalories were fats) in the parenteral nutrition because it is a source of essential fatty acids and because of its hypolipemiant and inmunomodulatory effect. With this treatment, patient achieved the lowest triglyceride levels in her life. So we could say that TPN enriched in w3 fatty acids and glutamine was safe and effective in our patient with significant decrease in triglyceride levels. This is the first case in the literature that describe this evolution in a patient with hypertriglyceridemia induced severe pancreatitis.