Muñoz Camila, De Toro Valeria, Gana Juan Cristóbal, Harris Paul R, Loureiro Carolina, Alberti Gigliola
Departamento de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Departamento de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Andes Pediatr. 2024 Apr;95(2):190-195. doi: 10.32641/andespediatr.v95i2.4967. Epub 2024 Mar 14.
Hypertriglyceridemia (HTG)-induced acute pancreatitis (AP) secondary to insulin deficiency following the onset of type 1 diabetes mellitus (T1DM) is a rare but serious complication in children.
To describe the diagnosis and treatment of severe HTG and to emphasize the need for timely diagnosis of T1DM.
A 15-year-old female adolescent with a history of overweight presented with a two-weeks history of fever, anorexia, and diffuse abdominal pain. Laboratory tests revealed triglycerides of 17,580 mg/dL, lipase of 723 U/L, and blood glucose of 200 mg/dL. An abdominal CT scan showed an enlarged and edematous pancreas. She was hospitalized with a diagnosis of AP and severe HTG, which progressed to acute necro-hemorrhagic pancreatitis. Treatment included continuous intravenous insulin infusion until triglyceride levels decreased. Upon discontinuation of insulin, fasting hyperglycemia (206 mg/dL) and metabolic acidosis recurred, therefore DM was suspected. Upon targeted questioning, a history of polydipsia, polyuria, and weight loss during the last 3 months stood out. Glycated hemoglobin was markedly elevated (14.7%). Insulin therapy was optimized, achieving stabilization of laboratory parameters after 15 days of treatment and complete anatomical resolution of pancreatic involvement at one year of follow-up.
The presence of severe HTG in pediatrics compels us to consider its secondary causes, such as the onset of T1DM. It is crucial to improve the ability to diagnose T1DM early, as it may present with infrequent and high-risk presentations for the patient.
1型糖尿病（T1DM）发病后因胰岛素缺乏继发的高甘油三酯血症（HTG）诱发的急性胰腺炎（AP）在儿童中是一种罕见但严重的并发症。
描述重度HTG的诊断和治疗，并强调及时诊断T1DM的必要性。
一名有超重病史的15岁女性青少年，出现发热、厌食和弥漫性腹痛两周。实验室检查显示甘油三酯为17,580 mg/dL，脂肪酶为723 U/L，血糖为200 mg/dL。腹部CT扫描显示胰腺肿大和水肿。她因AP和重度HTG入院，病情进展为急性坏死性出血性胰腺炎。治疗包括持续静脉输注胰岛素直至甘油三酯水平下降。停用胰岛素后，空腹血糖升高（206 mg/dL）和代谢性酸中毒复发，因此怀疑患有糖尿病。经针对性询问，过去3个月有多饮、多尿和体重减轻的病史较为突出。糖化血红蛋白明显升高（14.7%）。优化了胰岛素治疗，治疗15天后实验室参数稳定，随访一年时胰腺病变完全解剖学消退。
儿科中重度HTG的存在迫使我们考虑其继发原因，如T1DM的发病。早期诊断T1DM的能力至关重要，因为它可能以罕见且对患者有高风险的表现形式出现。
