Primary and Secondary Factors in Hypertriglyceridemia Induced Acute Pancreatitis: A Case-Based Focus Review

Abstract

Hypertriglyceridemia (HTG) is a known cause of pancreatitis. We described a case of severe hypertriglyceridemia (likely familial) causing the first episode of pancreatitis in this patient. A 21-year-old female known for hypertriglyceridemia and DM type 2 came to the emergency room with severe epigastric pain along with nausea and vomiting. Physical exam revealed epigastric tenderness, diminished bowel sounds, and signs of dehydration. Initial blood work was mostly unremarkable mildly elevated lipase 83. CT scan abdomen pelvis showing signs of peripancreatic inflammation. Additional workup revealed triglycerides > 5000 mg/dl. Diagnosis of hypertriglyceridemia-induced pancreatitis (HTGP) was made. The patient was treated with aggressive isotonic fluids, analgesics, and intravenous insulin therapy. This case highlights the presence of multiple secondary risk factors leading to severe HTG and HTGP in patients with the primary (genetic) predisposition. Incidence, pathophysiology, and management of HTGP will also be reviewed.