Acute pancreatitis secondary to oral contraceptive-induced hypertriglyceridemia: a case report

Stumpf, Matheo Augusto Morandi; Kluthcovsky, Ana Cláudia Garabeli Cavalli; Okamoto, Jefferson Matsuiti; Schrut, Gianna Carla Alberti; Cajoeiro, Patricia de Oliveira; Chacra, Ana Paula Marte; Bizeli, Ricardo

doi:10.1080/09513590.2018.1473365

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…Hypertriglyceridaemia accounts for up to a third of all cases in pregnancy in some Chinese series [133,134], likely in part because oestrogen alters lipid metabolism; preventative measures are desirable in those identified with high triglyceride levels [135]. Hypertriglyceridaemia-associated acute pancreatitis has been linked to oestrogen therapy for fertility treatment [136] and the oral contraceptive pill [137]; one cohort study of 31,494 women found a relative risk of 1.57 for acute pancreatitis in those receiving hormone replacement therapy [138]. As in non-pregnant patients, hypertriglyceridaemia-associated acute pancreatitis tends to be more severe than from other aetiologies, and in the context of pregnancy leads to greater maternal and fetal mortality [133].…”

Section: Acute Pancreatitis In Pregnancymentioning

confidence: 99%

Acute Pancreatitis: Diagnosis and Treatment

Szatmary

Grammatikopoulos

Cai

et al. 2022

Drugs

237

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Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal crosssectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.

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Section: Acute Pancreatitis In Pregnancymentioning

confidence: 99%

Acute Pancreatitis: Diagnosis and Treatment

Szatmary

Grammatikopoulos

Cai

et al. 2022

Drugs

237

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“…Contraceptive-induced hypertriglyceridaemia is attributed to the effects of oestrogen on hepatic TG lipase and lipoprotein lipase activity, resulting in elevated levels of low and intermediate-density triglycerides and cholesterol. Supporting evidence from studies conducted by Naz et al 8 and Stumpf et al 9 demonstrated statistically significant differences in TG levels between users and non-users of OCPs, further highlighting the impact of OCP use on lipid metabolism and the potential contribution of oestrogen-mediated mechanisms in altering TG levels.…”

Section: Discussionmentioning

confidence: 67%

OCP-driven hypertriglyceridaemia and recurrent acute pancreatitis

Thapa,

Allakky,

Turaga

2023

BMJ Case Rep

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Recurrent acute pancreatitis poses a significant challenge in clinical management. In this case, a young, obese woman with metabolic syndrome presented with her third episode of acute pancreatitis within a span of 4 months. Due to unavailability, plasmapheresis could not be performed, and the patient was managed solely with pharmacological therapy. Initial evaluation revealed abdominal pain, tenderness and elevated laboratory markers. CT scan findings indicated pancreatic and peripancreatic oedema. Further investigations highlighted the presence of hypertriglyceridaemia and hypocalcaemia. As the patient was using oral contraceptive pills (OCP), it was crucial to consider their potential role in causing hypertriglyceridaemia. Consequently, the patient was advised to discontinue OCP use. Despite the lack of plasmapheresis, intensive medical management, including medication and lifestyle modifications, showed positive results. This case underscores the importance of recognising the association between OCP, hypertriglyceridaemia and recurrent pancreatitis in patients with metabolic syndrome.

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“…COCs are contraindicated in severe dyslipidaemia, especially in patients with elevated TG, due to the increased risk of acute pancreatitis. In this clinical setting intrauterine devices should be recommended [56].…”

Section: Oestrogen/progesterone Excess and Oral Contraceptionmentioning

confidence: 99%

Endocrine diseases as causes of secondary hyperlipidemia

Bułdak

Marek

Kajdaniuk

et al. 2019

Endokrynologia Polska

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Cardiovascular diseases are among the leading causes of increased morbidity and mortality in developed and developing countries. One of the most important risk factors responsible for atherosclerosis and subsequent cardiovascular diseases is hyperlipidaemia. Currently, hyperlipidaemias are divided into several clinical entities. The greatest risk is associated with hypercholesterolaemia. As a result, modern guidelines for the treatment and prevention of atherosclerosis focus predominantly on the reduction of LDL-cholesterol. Hypertriglyceridaemia and atherogenic dyslipidaemia, which are responsible for a less significant increase in the cardiovascular risk, are nowadays secondary targets of the treatment. During the work-up for hyperlipidaemia one of the essential actions is the exclusion of secondary causes of the lipid abnormalities. Those include, among others, endocrine diseases, diabetes, drugs, nephrotic syndrome, and pregnancy. Data regarding the impact of endocrine disease and diabetes on the lipid profile are scattered. In this review, the authors aimed to perform a thorough analysis of the available publications regarding the topic and the preparation of a comprehensive review dealing with the incidence, clinical features, and the therapy of hyperlipidaemias in patients with endocrine disease.

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Acute pancreatitis secondary to oral contraceptive-induced hypertriglyceridemia: a case report

Cited by 6 publications

References 12 publications

Acute Pancreatitis: Diagnosis and Treatment

Acute Pancreatitis: Diagnosis and Treatment

OCP-driven hypertriglyceridaemia and recurrent acute pancreatitis

Endocrine diseases as causes of secondary hyperlipidemia

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