Can exenatide, an antidiabetic drug, cause chronic pancreatitis? A case presentation

Kader Ugur; Umur Ozbay; Mithat Mızrak; Suleyman Aydın

doi:10.1530/endoabs.90.EP433

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Endocrine Abstracts (2023) 90 EP433 | DOI: 10.1530/endoabs.90.EP433

ECE2023 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (355 abstracts)

Can exenatide, an antidiabetic drug, cause chronic pancreatitis? A case presentation

Kader Ugur ¹ , Umur Özbay ² , Mithat Mızrak ¹ & Süleyman Aydın ³

Err

Author affiliations

¹Faculty of Medicine, Firat University, Department of Internal Medicine (Endocrinology and Metabolism Diseases), Elazığ, Turkey; ²Faculty of Medicine, Firat University, Department of Internal Medicine, Elazığ, Turkey; ³Faculty of Medicine, Firat University, Department of Medical Biochemistry and Clinical Biochemistry (Firat Hormones Research Group), Elazığ, Turkey

Introduction: Pancreatitis is one of the serious side effects of glucagon-like peptide-1 receptor analog exenatide, which is an incretin hormone with anti-glycemic effects secreted from the intestine and is used for treating type 2 diabetes.

Case: A 60-year-old female patient with type 2 diabetes mellitus for 11 years had been using exenatide for 6 years (no history of acute pancreatitis) along with insulin glargine and metformin. She was admitted to the emergency department with complaints of nausea, vomiting, and abdominal pain radiating to the back for the last 3 days. The patient’s laboratory results are shown in Table 1. Possible factors, other than the ones associated with exenatide, (alcohol, hypertriglyceridemia, infections, and other drugs) were excluded. Contrast-enhanced computed tomography revealed multiple calcifications in the pancreatic parenchyma and irregular dilatation of the main pancreatic duct that was 17 mm in width at its widest point. Additionally, 7 mm calculus was found in the main pancreatic duct at the level of the papillary opening. These findings were indicative of chronic pancreatitis. In addition to these data, endoscopic retrograde cholangiopancreatography (ERCP) was performed. ERCP showed dilatations and stenosis along the entire pancreatic duct and fibrotic bands in the parenchyma, which indicated toward chronic pancreatitis. Therefore, exenatide was removed from the patient’s treatment regimen, and she was discharged and prescribed metformin, dapagliflozin, gliclazide MR, and glargine.

Table 1 Demographic and laboratory data in the diabetic patient
Age (year)	60
BMI (kg/m^²)	29.4
Amylase (U/l)	46 (28-100)
Lipase (U/l)	26 (7-60)
T.Cholesterol (mg/dl)	150 (120-200)
LDL (mg/dl)	112 (0-130)
Triglyceride (mg/dl)	87 (40-180)
HbA1c (%)	9.6 (4.6-6)
Creatinine (mg/dl)	0.5 (0.6-1.2)
AST (UL)	17 (5-40)
ALT (UL)	8 (5-40)
ALP (U/l)	113 (30-120)
GGT (U/l)	14 (0-55)
T. Bilirubin (mg/dl)	0.3 (0-1.1)
D. Bilirubin (mg/dl)	0.1 (0-0.35)
Hb (g/dl)	12.9 (11.1-17.1)
Plt (×109/l)	438 (140-360)
WBC (×109/l)	11.74 (3.8-8.6)
Albumin (g/dl)	4.07 (3.5-5.3)
Ca (mg/dl)	8.62 (8.5-10.8)

Discussion: It has been reported that the risk of pancreatitis in patients with diabetes is 3–4 times higher than in the non-diabetic population. The risk of pancreatitis in general patient population using exenatide is 0.34–0.44 times higher than other patients. This risk is 2.83 times higher in people with diabetes. As the risk of pancreatitis is increased in patients with diabetes mellitus using exenatide, it might be beneficial to prescribe alternative drugs to these patients.