Tselovalnikova Tatiana, Fatima Ifrah, Barthel Brandon
Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
AACE Clin Case Rep. 2024 Jul 22;10(5):210-213. doi: 10.1016/j.aace.2024.07.006. eCollection 2024 Sep-Oct.
BACKGROUND/OBJECTIVE: Although estrogen is one of the main agents used to treat transgender women, there are few reports of acute pancreatitis (AP) of this illness in this group. The objective of this report is to describe a transgender woman who developed AP in the setting of estrogen treatment and gallstone disease.
A 38-year-old transgender woman presented with severe abdominal pain and vomiting. Her medical history included gender dysphoria managed with gender-affirming hormone therapy comprising estradiol valerate, progesterone, and spironolactone. Initial management involved supportive care, antibiotic therapy, and endoscopic retrograde cholangiopancreatography with biliary stent placement. Imaging confirmed acute interstitial edematous pancreatitis without necrosis, guiding treatment decisions toward laparoscopic cholecystectomy. Pathological examination revealed multiple gallstones, affirming the diagnosis of AP secondary to choledocholithiasis, likely associated with estrogen use. Postprocedural recovery was uneventful, with eventual removal of the biliary stent and resolution of symptoms.
There are only 7 reported cases in literature on estrogen-induced AP in transgender individuals undergoing gender-affirming hormone therapy. Most of these were primarily linked to hypertriglyceridemia.
High-dose estrogen therapy in transgender women can elevate the risk of AP through the development of gallstones, underscoring the importance of thorough patient evaluation and discussion of risks assessment prior to initiating hormone therapy.
背景/目的：尽管雌激素是用于治疗变性女性的主要药物之一，但该群体中关于这种疾病引发急性胰腺炎（AP）的报道较少。本报告的目的是描述一名在接受雌激素治疗和胆结石疾病背景下发生急性胰腺炎的变性女性。
一名38岁的变性女性出现严重腹痛和呕吐。她的病史包括通过包含戊酸雌二醇、孕酮和螺内酯的性别确认激素疗法治疗的性别焦虑症。初始治疗包括支持性护理、抗生素治疗以及内镜逆行胰胆管造影术并放置胆道支架。影像学检查证实为急性间质性水肿性胰腺炎，无坏死，这为腹腔镜胆囊切除术的治疗决策提供了指导。病理检查发现多个胆结石，证实了继发于胆总管结石的急性胰腺炎的诊断，可能与雌激素的使用有关。术后恢复顺利，最终取出胆道支架，症状缓解。
在接受性别确认激素治疗的变性个体中，文献报道的雌激素诱导的急性胰腺炎仅有7例。其中大多数主要与高甘油三酯血症有关。
变性女性的高剂量雌激素治疗可通过胆结石的形成增加急性胰腺炎的风险，强调了在开始激素治疗前对患者进行全面评估和讨论风险评估的重要性。
