Endocrine Abstracts

Introduction

Severe hypertriglyceridemia (sHTG) (plasma triglycerides b 10 g/l) is a rare but pernicious and understudied condition.

Objective

Our objective was to evaluate the etiology, characteristics, and complications of sHTG.

Methods

It’s a retrospective study including 10 patients with (sHTG) diagnosed between 1998 and 2020, at the department of endocrinology at Hedi Chaker-hospital Sfax-Tunisia.

Results

Notable male predominance was noted (sex ratio = 4), the mean age was 30.1 years (18–40). Family history of metabolic disorders was reported: dyslipidemia (50%), HTA (80%), diabetes (60%). Past history of Diabetes was reported for 5 patients: diabetes type 2, diabetes type 1, and diabetes secondary to chronic pancreatitis, maternally inherited diabetes in 60%, 20%, 20%, and 20% respectively. 6 patients were being followed for dyslipidemia, 2 of them had chronic pancreatitis due to sHTG in pediatric age. 70% of patients had body mass index (BMI) between 25 and 30 kg/m². Also, alcohol consumption was reported in 3 cases with mean consumption of 55 g/per day. All of diabetic patients had a poorly controlled diabetes during hospitalization with mean HBA1c of 11.6%. Symptoms reported were: vomiting (6 patients), epigastria pain (7 patients), and weight loss (7 patients). Eruptive xanthoma was notable only for one patient. The mean fasting Plasma TG level was 19.92 g/l (10.5 to 34). Extremely severe hypertriglyceridemia TG b 30 g/l was reported in 2 cases. Abdominal imaging findings included acute pancreatitis signs (7 cases) in addition to hepatic steatosis. Necrotizing pancreatitis occurred in about 71% of acute pancreatitis cases. Lipoprotein electrophoresis helped to determine the causes of dyslipidemia in our study. Dyslipidemia type IV was the most common etiology (6 patients) and dyslipidemia type IIB was observed in 30% of cases. However, dyslipidemia type V was notable only for 1 patient. All patients received a fibrate (range of dose from 160 to 320) as either monotherapy or part of combination lipid-lowering therapy. We report a case of rhabdomyolysis induced by high dose of fibrate 320 mg/day associated with statin 20 mg/day. These therapeutic strategy including diet and intensification of diabetes treatment contributed to a decrease in the average triglyceride level of 72.8%.

Conclusion

These findings highlight the importance of early identification and successful treatment of severe HTG and its underlying disorders to reduce the risk of recurrent pancreatitis.