Chaudhry Arslan, Yelisetti Rishitha, Millet Christopher, Biggiani Christopher, Upadhyay Shivanck
Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA.
Pulmonary and Critical Care Medicine, St. Joseph's Regional Medical Center, Paterson, USA.
Cureus. 2021 Jul 3;13(7):e16140. doi: 10.7759/cureus.16140. eCollection 2021 Jul.
Hypertriglyceridemia (HTG) is an uncommon but well-established etiology of acute pancreatitis (AP) leading to significant morbidity and mortality. Hormone replacement therapy in the transgender population is an underrecognized cause of elevated triglyceride (TG) levels and may put this group at a higher risk for severe pancreatitis. We present a case of AP in a genetically male patient receiving hormone therapy for female gender transformation.A 51-year-old with a past medical history of type 2 diabetes mellitus presented with severe epigastric abdominal pain associated with nonbilious, nonbloody vomiting and anorexia for two days. The patient was diagnosed with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) in the setting of elevated lipase levels of 2,083 u/L and TGs of >5,000 mg/dL. In addition, a computerized tomography scan of the abdomen showed pancreatitis without evidence of necrosis. The patient was admitted to the medical intensive care unit for the management of AP in the setting of elevated TG levels. She was treated with intravenous fluids and an insulin drip. Her home medications including estradiol and Aldactone were held. Once the TG levels were reduced to <500 mg/dL, she was taken off the Insulin drip and transitioned to a subcutaneous insulin regimen along with gemfibrozil and omega-3 fatty acid over the next three days, and then discharged to home. HTG accounts for only about 7% of pancreatitis cases and increases in severity as TG levels increase. The clinical presentation of patients suffering from HTG-AP is similar to patients with AP from other etiologies and presents in a relatively younger population compared to AP from other causes. Treatment options for HTG-AP usually utilize insulin and heparin; however, plasma exchange and venovenous filtration may be used for severe cases of HTG-AP. The goal of treatment is to lower the TG levels. Physicians should be aware of such complications and should counsel patients while utilizing hormone replacement therapy, especially in patients with a prior family history of dyslipidemia.
高甘油三酯血症（HTG）是急性胰腺炎（AP）一种虽不常见但已明确的病因，可导致严重的发病率和死亡率。跨性别群体中的激素替代疗法是甘油三酯（TG）水平升高的一个未被充分认识的原因，可能使该群体面临更严重胰腺炎的更高风险。我们报告一例正在接受激素治疗以转变为女性性别的基因男性患者发生急性胰腺炎的病例。一名有2型糖尿病病史的51岁患者，出现严重上腹部腹痛，伴有非胆汁性、非血性呕吐和厌食两天。患者在脂肪酶水平升至2083 U/L且TG>5000 mg/dL的情况下，被诊断为高甘油三酯血症诱发的急性胰腺炎（HTG-AP）。此外，腹部计算机断层扫描显示有胰腺炎但无坏死迹象。患者因TG水平升高导致的急性胰腺炎入住医学重症监护病房。给予静脉补液和胰岛素静脉滴注治疗。停用其包括雌二醇和安体舒通在内的家庭用药。一旦TG水平降至<500 mg/dL，停用胰岛素静脉滴注，并在接下来三天过渡为皮下胰岛素治疗方案，同时服用吉非贝齐和ω-3脂肪酸，然后出院回家。HTG仅占胰腺炎病例的约7%，且随着TG水平升高严重程度增加。HTG-AP患者的临床表现与其他病因导致的急性胰腺炎患者相似，且与其他原因导致的急性胰腺炎相比，发病年龄相对较轻。HTG-AP的治疗选择通常使用胰岛素和肝素；然而，血浆置换和静脉静脉滤过可用于HTG-AP的重症病例。治疗目标是降低TG水平。医生应意识到此类并发症，在使用激素替代疗法时应向患者提供咨询，尤其是有血脂异常家族史的患者。
