title: Case report of acute necrotizing pancreatitis associated with combination treatment of sitagliptin and exenatide.
abstract: OBJECTIVE
  To report the first postmarketing case of necrotizing pancreatitis in a patient on combination therapy of sitagliptin and exenatide.
  
  
  METHODS
  We describe the patient's clinical presentation, laboratory test results, imaging, and autopsy findings.
  
  
  RESULTS
  A 76-year-old woman with a history of type 2 diabetes mellitus presented with severe abdominal pain, vomiting, and fever requiring hospital admission. She had been treated with exenatide for 3 years to manage her diabetes mellitus. A few weeks before presentation, sitagliptin was added, presumably to further optimize her glycemic control. Acute pancreatitis was diagnosed during hospital admission. At initial presentation, her serum amylase concentration was 1136 U/L (reference range, 10-130 U/L) and her lipase concentration was greater than 3500 U/L (reference range, 0-75 U/L). In addition, computed tomography of the abdomen and pelvis demonstrated extensive previous cholecystectomy, reported no alcohol consumption, and had a normal lipid profile. Although she had a long-standing history of diabetes mellitus, she had no history of pancreatitis or other risk factors that would have caused her to develop the underlying condition. After initial brief improvement, her symptoms worsened, and despite aggressive care, her clinical state deteriorated and she died. Autopsy findings demonstrated acute necrotizing pancreatitis with complete digestion of the pancreas.
  
  
  CONCLUSIONS
  Considering the temporal relationship of her symptoms to the addition of sitagliptin to her existing exenatide regimen, this case strongly suggests a possible causal link between exenatide or sitagliptin (or the combination of the 2 drugs) and the etiology of pancreatitis in this patient.
authors: Department of Internal Medicine, East Carolina University, Greenville, North Carolina 27834, USA.
authors: Shridhar N
authors: SN
authors: Iyer
authors: Almond J
authors: AJ
authors: Drake
authors: R Lee
authors: RL
authors: West
authors: Carlos E
authors: CE
authors: Mendez
authors: Robert J
authors: RJ
authors: Tanenberg
mesh_terms: D000368:Aged; D000681:Amylases / Q000097:blood; D001344:Autopsy; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000077270:Exenatide; D017809:Fatal Outcome; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000819:agonists; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008049:Lipase / Q000097:blood; D008055:Lipids / Q000097:blood; D008111:Liver Function Tests; D010179:Pancreas / Q000473:pathology; D019283:Pancreatitis, Acute Necrotizing / Q000139:chemically induced* / Q000473:pathology; D010455:Peptides / Q000009:adverse effects* / Q000627:therapeutic use; D011719:Pyrazines / Q000009:adverse effects* / Q000627:therapeutic use; D000068900:Sitagliptin Phosphate; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use; D014688:Venoms / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids; D010455:Peptides; D011719:Pyrazines; D014230:Triazoles; D014688:Venoms; D052216:Glucagon-Like Peptide 1; D000077270:Exenatide; D008049:Lipase; D000681:Amylases; D000068900:Sitagliptin Phosphate