Wadood Ali, Chesner Robert, Mirza Mehboob, Zaman Shafquat
Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK.
BMJ Case Rep. 2016 Aug 3;2016:bcr2016214837. doi: 10.1136/bcr-2016-214837.
Drug-induced pancreatitis is uncommon, and is estimated to account for between 0.1% and 5% of cases. Tamoxifen is commonly used in the management of oestrogen receptor-positive breast cancer. We present a rare case of tamoxifen-related hyperlipidaemia resulting in repeated episodes of pancreatitis, which, to the best of our knowledge, has only been documented a few times in the literature. A 36-year-old woman with familial hypertriglyceridaemia presented with recurrent episodes of abdominal pain, modest increases in serum amylase levels and normal liver function tests. The patient had recently been diagnosed with breast carcinoma and was managed with wide local excision (WLE), adjuvant radiotherapy and tamoxifen. On each admission, the patient's symptoms were confirmed either biochemically and/or radiologically. Analysis of the case led to a diagnosis of precipitation of familial hypertriglyceridaemia from tamoxifen use resulting in pancreatitis. Management was altered with tamoxifen cessation and initiation of second-line hormonal therapy. Tamoxifen use needs consideration, especially in those with familial hyperlipidaemia.
药物性胰腺炎并不常见，估计占病例的0.1%至5%。他莫昔芬常用于雌激素受体阳性乳腺癌的治疗。我们报告一例罕见的与他莫昔芬相关的高脂血症导致反复胰腺炎发作的病例，据我们所知，该病例在文献中仅有少数几次记载。一名患有家族性高甘油三酯血症的36岁女性出现反复腹痛、血清淀粉酶水平适度升高且肝功能检查正常。该患者最近被诊断为乳腺癌，并接受了广泛局部切除（WLE）、辅助放疗和他莫昔芬治疗。每次入院时，患者的症状均通过生化和/或放射学检查得以证实。对该病例的分析得出诊断结果，即使用他莫昔芬引发家族性高甘油三酯血症沉淀，进而导致胰腺炎。治疗方案改为停用他莫昔芬并开始二线激素治疗。使用他莫昔芬时需要加以考虑，尤其是对于那些患有家族性高脂血症的患者。
