Endocrine Abstracts

Backgound: Familial hypertriglyceridemia may lead to acute pancreatitis also during pregnancy in some cases. We present two cases with hypertriglyceridemia-induced pancreatitis that recurred despite diet and medical therapy during pregnancy.

Case presentation: Twenty-eight-year-old woman presented with hypertriglyceridemia-induced pancreatitis (serum triglyceride: 8502 mg/dL) that was complicated with respiratory distress at 25 weeks of gestation. Following plasmapheresis serum triglyceride level was 613mg/dL but her pregnancy was terminated due to intrauterine fetal demise. She was started on fenofibrate therapy but was lost to follow-up. One year later, she presented with acute pancreatitis (serum triglyceride: 2425 mg/dL) again during pregnancy at 23^rd week. She improved after plasmapheresis but refused gemfibrozil therapy. Four weeks later pancreatitis recurred(serum triglyceride: 4382 mg/dL), she was put on gemfibrozil and regular plasmapheresis was planned to prevent recurrences. Plasmapheresis was performed 8 times between 28^th and 35^th weeks with intervals based on triglyceride levels. The mean decrease in triglyceride was 62%. She gave birth to a healthy female infant at 35^th+3/7 week (Apgar 1.min: 8, 5.min:10; weight: 2470gr). Second patient was a 24-year-old woman with untreated hypertriglyceridemia who presented with acute pancreatitis (serum triglyceride: 1268 mg/dL) at 23^rd gestational week. The pancreatitis resolved without complications following plasmapheresis. Gemfibrozil therapy (1200 mg/day) and fish oil were started and serum triglyceride levels remained around 1054–1381 mg/dL. Five weeks later, pancreatitis recurred(serum triglyceride:3069 mg/dL) and plasmapheresis on a 2-week-basis was applied until delivery. She did not experience pancreatitis thereafter and gave birth to a healthy female infant at 39^th+4/7 week (Apgar 1.min:8, 5.min: 10; weight: 3230gr).

Conclusion: Regular plasmapheresis may be an option for unique cases such as pregnant patients with familial hypertriglyceridemia to prevent recurrent pancreatitis.