Endocrine Abstracts

Pancreatitis has multiple aetiologies of which commonest are gall stones and alcohol. Hypertriglyceridaemia is a less common (1-14 %) cause of pancreatitis. We present three case histories of acute pancreatitis due to severe triglyceridaemia and its management challenge in people with diabetes.

Case history: 1. A 33-year-old man with BMI of 41 kg/m² with Hodgkin lymphoma, thyrotoxicosis and diabetes, but no history of alcohol use was diagnosed to have pancreatitis. Biochemical profile revealed total cholesterol (TC) 26.8 mmol/l (nr 0-5), triglyceride 90.5 mmol/l (0.8-1.8), HDL-cholesterol (HDL-C) <0.08 mmol/l. No gall stones were detected. He was treated with intravenous insulin and plasma exchange which lowered triglyceride levels to 6.8 mmol/l. He was later initiated on atorvastatin, fibrate and biphasic insulin.

Case history: 2. A 23-year-old man with type 2 diabetes and no history of alcohol use or gall stones was diagnosed with pancreatitis. Biochemical profile revealed TC 11.5 mmol/l, triglycerides 44.9 mmol/l and HDL-C 0.31 mmol/l. He was treated with intravenous insulin infusion initially and later with atorvastatin, fibrate and biphasic insulin. Triglyceride levels were lowered to 3.5 mmol/l.

Case history: 3. A 53-year-old man with pancreatitis thought to be due to non-obstructive gall stones 6 months previously, was awaiting elective laparascopic cholecystectomy. Pre-operative bloods tests revealed TC 20.7 mmol/l, triglyceride 59.4 mmol/l and HDL-C 0.22 mmol/l. He was initiated on metformin, biphasic insulin, atorvastatin, fibrate and ezetimibe. TC went down to 3.9 mmol/l, triglyceride to 4.39 mmol/l and HDL-C to 0.66 mmol/l.

Conclusion: Our case histories highlight the importance of checking lipid profile in every patient with diabetes presenting with acute pancreatitis. Insulin therapy, either intravenously or sub-cutaneously seems to rapidly reduce triglyceride levels in such patients.