Hypertriglyceridemia-induced Acute Pancreatitis in Pregnancy

Mindaugas Serpytis; Vytautas Karosas; Rokas Tamosauskas; Jurate Dementaviciene; Kestutis Strupas; Audrius Sileikis; Jurate Sipylaite

doi:10.6092/1590-8577/1148

Mindaugas Serpytis Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius University. Vilnius, Lithuania
Vytautas Karosas Centre of Anesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santariskiu Klinikos. Vilnius, Lithuania
Rokas Tamosauskas Department of Anaesthesia, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust. Cambridge, United Kingdom
Jurate Dementaviciene Department of Radiology, Nuclear Medicine and Medicine Physics, Faculty of Medicine, Vilnius University. Vilnius, Lithuania
Kestutis Strupas Clinic of Gastroenterology, Nephrourology and Surgery, Faculty of Medicine, Vilnius University. Vilnius, Lithuania
Audrius Sileikis Centre of Abdominal Surgery, Vilnius University Hospital Santariskiu Klinikos. Vilnius, Lithuania
Jurate Sipylaite Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius University. Vilnius, Lithuania

DOI: https://doi.org/10.6092/1590-8577/1148

Keywords: Hypertriglyceridemia, Pancreatitis, Acute Necrotizing, Pregnancy

Abstract

Context Hypertriglyceridemia is a well known phenomenon of pregnancy occuring due to physiologic changes in sex hormone levels. Occasionally, it could lead to development of acute pancreatitis. Gestational hypertriglyceridemia-induced acute pancreatitis occurs in pregnant women usually with preexisting abnormalities of the lipid metabolism and is associated with additional diagnostic and therapeutic challenges related to hypertriglyceridemia and pregnancy. Case report We present a case of the hypertriglyceridemia-induced acute pancreatitis in pregnant woman with no previous history of lipid abnormality and pregnancy as the only known triggering factor for hypertriglyceridemia. Conclusions Hypertriglyceridemia-induced acute pancreatitis is a rare complication of pregnancy; however, it should be suspected in all pregnant patients admitted for nonobsteric abdominal pain.

Image: CT image showing a diffusely enhancing and enlarged pancreas with hypodense foci in the pancreatic head.

Downloads

Download data is not yet available.

References

Pitchumoni CS, Yegneswaran B. Acute pancreatitis in pregnancy. World J Gastroenterol 2009; 15:5641-6. [PMID:19960559].

Eddy JJ, Gideonsen MD, Song JY, Grobman WA, O'Halloran P. Pancreatitis in pregnancy. Obstet Gynecol 2008; 112:1075-81. [PMID: 18978108].

Gursoy A, Kulaksizoglu M, Sahin M, Ertugrul DT, Ozer F, Tutuncu NB, et al. Severe hypertriglyceridemia-induced pancreatitis during pregnancy. J Natl Med Assoc 2006; 98:655-7. [PMID: 16623082].

Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol 2003; 36:54-62. [PMID: 12488710].

Kim HJ, Kalkhoff RK. Sex steroid influence on triglyceride metabolism. J Clin Invest 1975; 56:888-96. [PMID: 1159092].

Herrera E, Lasuncion MA, Gomez-Coronado D, Aranda P, Lopez-Luna P, Maier I. Role of lipoprotein lipase activity on lipoprotein metabolism and the fate of circulating triglycerides in pregnancy. Am J Obstet Gynecol 1988; 158:1575-83. [PMID: 3287929].

Saharia P, Margolis S, Zuidema GD, Cameron JL. Acute pancreatitis with hyperlipemia: studies with an isolated perfused canine pancreas. Surgery 1977; 82:60-7. [PMID: 877857].

Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 2005; 190:467-73. [PMID: 16105538].

Lurie S, Rahamim E, Piper I, Golan A, Sadan O. Total and differential leukocyte counts percentiles in normal pregnancy. Eur J Obstet Gynecol Reprod Biol 2008; 136:16-9. [PMID: 17275981].

Milman N, Bergholt T, Byg KE, Eriksen L, Hvas AM. Reference intervals for haematological variables during normal pregnancy and postpartum in 434 healthy Danish women. Eur J Haematol 2007; 79:39-46. [PMID: 17598837].

Kroll MH, Elin RJ. Interference with clinical laboratory analyses. Clin Chem 1994; 40:1996-2005. [PMID: 7955368].

Wickus GG, Dukerschein RO, Pierce JR, Davis KD. Interference in a chromogenic alpha-amylase assay caused by dye-labeled oligosaccharide-induced precipitation of lipoprotein. Clin Chem 1982; 28:2131-4. [PMID: 6181910].

Warshaw AL, Bellini CA, Lesser PB. Inhibition of serum and urine amylase activity in pancreatitis with hyperlipemia. Ann Surg 1975; 182:72-5. [PMID: 1147712].

Beddy P, Keogan MT, Sala E, Griffin N. Magnetic resonance imaging for the evaluation of acute abdominal pain in pregnancy. Semin Ultrasound CT MRI 2010; 31:433-41. [PMID: 20974361].

Martin JM, Stapleton RD. Omega-3 fatty acids in critical illness. Nutr Rev 2010; 68:531-41. [PMID: 20796218].

Henzen C, Rock M, Schnieper C, Heer K. Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis. Schweiz Med Wochenschr 1999; 129:1242-8. [PMID: 10499250].

Ewald N, Kloer HU. Severe hypertriglyceridemia: an indication for apheresis? Atheroscler Suppl 2009; 10:49-52. [PMID: 20129374].

Mao EQ, Tang YQ, Zhang SD. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis. World J Gastroenterol 2003; 9:2622-6. [PMID: 14606112].

Klingel R, Gohlen B, Schwarting A, Himmelsbach F, Straube R. Differential indication of lipoprotein apheresis during pregnancy. Ther Apher Dial 2003; 7:359-64. [PMID: 12924613].