Endocrine Abstracts

Introduction: Hypertriglyceridemia (HTG) is a rare but well-known cause of acute pancreatitis, which can be fatal with an overall mortality rate of 36-50% in the most severe forms.

Case presentation: A 29-year-old patient was admitted to the emergency department with abdominal pain, bilious vomiting and alteration of general condition. Physical examination showed hemodynamic shock with diffuse abdominal tenderness. The Laboratory results showed a serum lipase of 546 U/l (higher than 6 times the upper limit of normal), a severe hypertriglyceridemia at 94 g/l and hypercholesterolemia at 11 g/l. Abdominal ultrasound did not show lithiasis, abdominal CT scan revealed Balthazar grade E pancreatitis and magnetic resonance cholangiopancreatography (MRCP) did not show microlithiasis of the gallbladder and biliary ducts. Pancreatic autoantibodies were negative. The diagnosis of acute pancreatitis due to major hypertriglyceridemia was made. The patient was managed with fasting, intravenous hydration, heparin and fibrate therapy. The evolution was marked by a clinico-biological improvement.

Discussion: The association between acute pancreatitis and HTG is widely recognized. It presents 12-38% of all acute pancreatitis. The symptomatology of this acute pancreatitis is unremarkable. The management of major hypertriglyceridemia is based on symptomatic treatment combining effective analgesia, parenteral nutrition, adequate hydration and lipid-free nutrition. Other therapies have been reported, such as heparin infusion and insulin. Plasma exchange may be useful, although its clinical efficacy has not been proven.

Conclusion: Hypertriglyceridemia is a rare cause of acute pancreatitis. It requires specific treatment to overcome the acute phase and prevent recurrence.