Hypertriglyceridemic pancreatitis: presentation and management.
Hypertriglyceridemia (HTG) is reported to cause 1-4% of acute pancreatitis (AP) episodes. HTG is also implicated in more than half of gestational pancreatitis cases. Disorders of lipoprotein metabolism are conventionally divided into primary (genetic) and secondary causes, including diabetes, hypothyroidism, and obesity. Serum triglyceride (TG) levels above 1,000 mg/dl are usually considered necessary to ascribe causation for AP. The mechanism for hypertriglyceridemic pancreatitis (HTGP) is postulated to involve hydrolysis of TG by pancreatic lipase and release of free fatty acids that induce free radical damage. Multiple small studies on HTGP management have evaluated the use of insulin, heparin, or both. Many series have also reported use of apheresis to reduce TG levels. Subsequent control of HTG with dietary restrictions, antihyperlipidemic agents, and even regular apheresis has been shown anecdotally in case series to prevent future episodes of AP. However, large multicenter studies are needed to optimize future management guidelines for patients with HTGP.
Tsuang
Wayne
W
Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
Navaneethan
Udayakumar
U
Ruiz
Luis
L
Palascak
Joseph B
JB
Gelrud
Andres
A
D001781:Blood Component Removal / Q000379:methods*; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000150:complications / Q000628:therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008071:Lipoprotein Lipase / Q000097:blood / Q000187:drug effects; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*
D005343:Fibrinolytic Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007328:Insulin; D014280:Triglycerides; D006493:Heparin; D008071:Lipoprotein Lipase