Severe hypertriglyceridemia in a subject with disturbed life style and poor glycemic control without recurrence of acute pancreatitis: a case report

Abstract

Background Hypertriglyceridemia is often observed as the result of lipid abnormality and frequently associated with other lipid and metabolic disorders. Aggravation of hypertriglyceridemia is caused by various conditions. However, severe hypertriglyceridemia is usually induced by an addition of some secondary clinical conditions such as uncontrolled type 2 diabetes mellitus (T2DM) and obesity with insulin resistance. Case presentation A 40-year-old man with 4-year history of dyslipidemia and T2DM visited after his interruption of therapy for about 1.5 years. His past history was acute pancreatitis. His life style was markedly disturbed, and he had a lot of risk factors for hypertriglyceridemia. Surprisingly, his serum triglyceride level was as high as 16,900 mg/dL. His aggravation and remission of hypertriglyceridemia were closely associated with the alteration of RLP-cholesterol levels in dyslipidemia and glycoalbumin and ketone body levels in T2DM. Conclusion We report very severe hypertriglyceridemia, which seemed to be caused by markedly disturbed life style and poorly controlled T2DM. Total therapy with diet and drug for each disease is very important for the improvement of very severe hypertriglyceridemia. This case report suggests that very severe hypertriglyceridemia alone does not necessarily bring out acute pancreatitis, although it is very important to check pancreatitis markers in such a situation.

Delayed diagnosis and treatment of extreme hypertriglyceridemia due to rejection of a lipemic sample

“…The risk to develop acute pancreatitis rises with increasing TG concentrations, although the severity of pancreatitis does not appear to correlate with TG concentration (18). Despite the extreme HTG, our patient did not develop acute pancreatitis, a finding that has also been demonstrated by other case reports (19,20). The fast initiation of therapeutic plasma exchange may have contributed to preventing acute pancreatitis since a fast reduction of TG concentration is most effective when initiated shortly after presentation (21).…”

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

“…Patients in this study and in previous case reports were mostly young adults or children (Tables 1 and 4). 23,24 Interestingly, some patients with serum triglyceride levels higher than 10 000 mg/dL did not develop AP, suggesting that very severe hypertriglyceridemia is not sufficient to cause 25,26 . Other factors, such as obesity and diabetes, may also play a role in the pathogenesis of AP; however, this is still controversial.…”

“…23,24 Interestingly, some patients with serum triglyceride levels higher than 10 000 mg/dL did not develop AP, suggesting that very severe hypertriglyceridemia is not sufficient to cause. 25,26 Other factors, such as obesity and diabetes, may also play a role in the pathogenesis of AP; however, this is still controversial. DKA is a common complication of diabetes that is caused by insulin deficiency.…”

Eruptive xanthomas: a warning sign of future hyperlipidemia complications

“…While previous cases have reported extreme hypertriglyceridemia with resolution, none, to the authors' knowledge, have accomplished it at this rate. [28][29][30] Exceptional reduction as seen in other literature demonstrated a triglyceride reduction of nearly 50% within days and 75% within weeks. This marked decrease suggests that the multimodal treatment with concomitant lifestyle changes can result in exceptional reduction of triglycerides, at rates not documented previously.…”