Endocrine Abstracts

JOINT1970

Introduction: The triad of ketoacidosis, acute pancreatitis and hypertriglyceridaemia is a very rare phenomenon. The metabolic origin seems to be the cause of this hypertriglyceridaemia(HTG) responsible for pancreatitis(PA).

Observation: A 48-year-old woman was admitted to hospital with abrupt onset of abdominal pain. She had a 2-year history of diabetes and was taking oral antidiabetics. Clinical examination revealed grade 2 obesity with abdominal obesity and acanthosis nigricans. Biological tests revealed metabolic acidosis, hyperglycaemia of 5.6 g/l, triglycerides of 10.2 g/l, lipasemia of 1000 IU/l, and HbA1c of 13%. Abdominal CT confirmed stage E pancreatitis. The diagnosis of ketoacidosis was made in the context of type II diabetes and associated BP. The outcome was favourable within a few days on insulin, with disappearance of pain and regression of ketoacidosis. At the same time, triglyceride levels and other biological parameters rapidly returned to normal.

Discussion: In our case, several mechanisms appear to be interrelated. The high triglyceride level at the time of diagnosis and the rapid reduction after correction of ketoacidosis are in favour of the metabolic origin of this HTG linked to CAD itself. However, it has been shown that major HTG can trigger BP, which usually progresses quite severely.

Conclusion: In conclusion, when significant abdominal pain appears in a patient with AD, we believe it is appropriate to suggest a lipasemia assay. If this assay is three times normal, the diagnosis of PA is likely and an abdominal CT scan should be ordered. Triglyceride levels should be measured at the same time to confirm that the BP is indeed secondary to HTG.