Reddy Shrenika, Ahmad Zahid
Division of Endocrinology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8857, United States.
Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8857, United States.
J Clin Lipidol. 2022 Jul-Aug;16(4):417-422. doi: 10.1016/j.jacl.2022.04.002. Epub 2022 Apr 21.
Few cases of hypertriglyceridemic pancreatitis have been reported in women during a vitro fertilization treatment (IVF) cycle. Here, we describe a 41-year-old woman with primary infertility and a history of acute pancreatitis (of unknown etiology) who was started on high dose ethinyl estradiol to prepare for transfer of cryopreserved embryos. She subsequently presented with nausea, vomiting, and abdominal pain to an emergency room and was found to have hypertriglyceridemic pancreatitis. Her hospitalization involved a prolonged intensive care unit stay in which she underwent three sessions of plasmapheresis. Eventually, with discontinuation of ethinyl estrogen, aggressive intravenous fluid hydration, plasmapheresis, a low-fat diet, and gemfibrozil, she had resolution of severe hypertriglyceridemia and all symptoms related to acute pancreatitis. Our case highlights the possibility that ethinyl estradiol, a commonly used form of estrogen for endometrial preparation during IVF cycles, may cause severe hypertriglyceridemia and acute pancreatitis in certain predisposed individuals. Only seven cases of hypertriglyceridemic pancreatitis during in vitro fertilization have been previously reported, and only one of these prior cases experienced pancreatitis during transfer of cryopreserved embryos like our patient. Our case, along with the few prior reported cases, demonstrate hypertriglyceridemic pancreatitis can occur during IVF. Further work is needed to understand the effects of exogenous estrogen on lipids for women undergoing IVF.
在体外受精（IVF）周期中，女性发生高甘油三酯血症性胰腺炎的病例鲜有报道。在此，我们描述一名41岁的原发性不孕女性，有急性胰腺炎病史（病因不明），在准备移植冷冻胚胎时开始使用高剂量炔雌醇。她随后因恶心、呕吐和腹痛前往急诊室，被诊断为高甘油三酯血症性胰腺炎。她住院期间在重症监护病房停留了较长时间，期间接受了三次血浆置换治疗。最终，通过停用炔雌醇、积极静脉补液、血浆置换、低脂饮食以及使用吉非贝齐，她的严重高甘油三酯血症及所有与急性胰腺炎相关的症状得以缓解。我们的病例突出了一种可能性，即在IVF周期中常用于子宫内膜准备的雌激素形式炔雌醇，可能在某些易感个体中导致严重高甘油三酯血症和急性胰腺炎。此前仅报道过7例IVF期间发生的高甘油三酯血症性胰腺炎病例，其中只有1例与我们的患者一样在冷冻胚胎移植期间发生胰腺炎。我们的病例以及之前报道的少数病例表明，IVF期间可能发生高甘油三酯血症性胰腺炎。需要进一步开展工作以了解外源性雌激素对接受IVF的女性血脂的影响。
