Acute Pancreatitis Secondary to Hypertriglyceridemia during Pregnancy

Abstract

Introduction Hypertriglyceridemia (HTG) (triglycerides > 1,000 mg/dL [11.3 mmol/L]) has been associated with a high risk of developing acute pancreatitis (AP) in pregnant women, but this condition is rare. We present the case of a pregnant Saudi with AP secondary to HTG.

Case Report A 27-year-old Saudi female presented at 30 weeks' gestational age with abdominal pain, nausea, and vomiting of 4 days' duration. AP was diagnosed based on clinical presentation, high lipase, and abdominal ultrasound findings. Her triglyceride level was 58 mmol/L. Fenofibrate and intravenous regular insulin infusion with dextrose were started, which decreased triglycerides by the third day from 58.8 to 29 mmol/L (50% reduction) with a further reduction to 11 mmol/L (81%) by day 7 of her admission. Labor was induced at 37 weeks of gestation, and she delivered a healthy neonate.

Conclusion We report successful treatment of AP in pregnancy with intravenous insulin and fenofibrate. Several case reports have discussed the therapeutic option of AP induced by HTG in pregnancy. Lipid-lowering agents are category C in pregnancy. However, few case reports indicate their safety. Insulin, heparin, and apheresis have also been used during pregnancy without any complications.

Keywords

acute pancreatitis - hypertriglyceridemia - pregnancy

Consent

The patient consented prior to reporting the case.

Authors' Contributions

All named authors contributed to the conduct of the work, drafting, and finalization of the manuscript and approved its final version.

Compliance with Ethical Principles

No prior ethical approval is required for single case reports or small case series.

Publikationsverlauf

Artikel online veröffentlicht:
05. Dezember 2022

• References

• 1 Eddy JJ, Gideonsen MD, Song JY, Grobman WA, O'Halloran P. Pancreatitis in pregnancy. Obstet Gynecol 2008; 112 (05) 1075-1081
• 2 Abu Musa AA, Usta IM, Rechdan JB, Nassar AH. Recurrent hypertriglyceridemia-induced pancreatitis in pregnancy: a management dilemma. Pancreas 2006; 32 (02) 227-228
• 3 Fortson MR, Freedman SN, Webster III PD. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol 1995; 90 (12) 2134-2139
• 4 Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am 1990; 19 (04) 783-791
• 5 Gök F, Köker S, Kılıçaslan A, Sarkılar G, Yosunkaya A, Otelcioğlu Ş. Acute pancreatitis due to hypertriglyceridaemia in pregnancy. Turk J Anaesthesiol Reanim 2015; 43 (02) 116-118
• 6 Jeon HR, Kim SY, Cho YJ, Chon SJ. Hypertriglyceridemia-induced acute pancreatitis in pregnancy causing maternal death. Obstet Gynecol Sci 2016; 59 (02) 148-151 Korea.
• 7 Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13 (4, Suppl 2): e1-e15
• 8 Havel RJ. Pathogenesis, differentiation and management of hypertriglyceridemia. Adv Intern Med 1969; 15: 117-154
• 9 Navina S, Acharya C, DeLany JP. et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med 2011; 3 (107) 107ra110
• 10 Kashyap P, Prasad S, Singh CB. A rare case of severe hypertriglyceridemia induced pancreatitis in pregnancy. Int J Reprod Contracept Obstet Gynecol 2017; 6 (12) 5625-5627
• 11 Serpytis M, Karosas V, Tamosauskas R. et al. Hypertriglyceridemia-induced acute pancreatitis in pregnancy. JOP 2012; 13 (06) 677-680
• 12 Iverius PH, Brunzell JD. Relationship between lipoprotein lipase activity and plasma sex steroid level in obese women. J Clin Invest 1988; 82 (03) 1106-1112
• 13 Gürsoy A, Kulaksizoglu M, Sahin M. et al. Severe hypertriglyceridemia-induced pancreatitis during pregnancy. J Natl Med Assoc 2006; 98 (04) 655-657
• 14 Cansu GB, Yılmaz N, Altunbaş H, Balcı MK, Sarı R. Subcutaneous NPH insulin for severe hypertriglyceridemia in a pregnant patient with type V hyperlipoproteinemia: a case report. Balkan Med J 2012; 29 (02) 222-224
• 15 Sleth JC, Lafforgue E, Servais R. et al. A case of hypertriglycideremia-induced pancreatitis in pregnancy: value of heparin [in French]. Ann Fr Anesth Reanim 2004; 23 (08) 835-837
• 16 Gupta N, Ahmed S, Shaffer L, Cavens P, Blankstein J. Severe hypertriglyceridemia induced pancreatitis in pregnancy. Case Rep Obstet Gynecol 2014; 2014: 485493
• 17 Safi F, Qa'dan M, Toumeh A, Assaly R. Management of familial hypertriglyceridemia induced pancreatitis during pregnancy with therapeutic plasma exchange. Chest 2012; 142: 413
• 18 Saravanan P, Blumenthal S, Anderson C, Stein R, Berkelhammer C. Plasma exchange for dramatic gestational hyperlipidemic pancreatitis. J Clin Gastroenterol 1996; 22 (04) 295-298