Endocrine Abstracts

Introduction: Hypertriglyceridaemia is common and can be managed safely by treating the underlying cause like poorly controlled diabetes, profound hypothyroidism, obesity, alcohol excess but severe hypertriglyceridaemia (>5.6mmol/l) poses high risk of complications including pancreatitis, venous thromboembolism (VTE) and long-term cardiovascular complications. Urgent management is extremely important to reduce the above risks.

Case report: A 49-year-old man with a history of well-controlled asthma, heavy smoking, and alcohol excess admitted with osmotic symptoms (increased thirst and urination) and a year-long history of glove and stocking numbness and tingling. On examination, he had central adiposity with a body mass index of 31.4 kg/m². No clinical features of endocrinopathy like Cushing’s or acromegaly. His clinical picture was consistent with new-onset type 2 diabetes mellitus given an HbA1c of 135. He was noted to have severe hypertriglyceridemia with hypercholesterolaemia, as mentioned below. There were no clinical features of familial hypercholesterolaemia like tendon xanthoma or xanthelasma.

Investigations: Baseline investigations including full blood count, bone profile, C-reactive protein, renal functions, thyroid functions, coagulation profile, B12, folate, and amylase levels were normal but mild asymptomatic hyponatraemia (124 mmol/l). However, he had severely lipaemic serum with triglyceride levels of 63 (<1.7 mmol/l) and total cholesterol of 21.5 (<5mmol/l).

Management: He was successfully managed with a variable-rate insulin infusion (VRIII) at 0.05 units/kg/hour, 5% dextrose (100-150 ml/hour), and a high-dose prophylactic low molecular weight heparin, in addition to a low-calorie and fat-free diet.

Learning points: 1. It is extremely important to acutely reduce severe hypertriglyceridemia to alleviate the risk of pancreatitis and VTE. 2. Severe hypertriglyceridaemia can be successfully managed with VRIII without requiring plasmapheresis in majority of cases. 3. High dose VTE prophylaxis is equally important to reduce the risk of VTE secondary to hyperviscosity from hypertriglyceridemia.