Hypertriglyceridaemia-induced pancreatitis is an uncommon form of acute pancreatitis caused by high levels of circulating triglycerides in the blood.
On this page:
Epidemiology
Hypertriglyceridaemia-induced pancreatitis accounts for around 1-4% of cases of acute pancreatitis and is the third most common cause of pancreatitis after gallstones and alcohol 1. It is responsible for over half of pregnancy-related cases of acute pancreatitis 2.
Risk factors
Presence of the following may heighten suspicion for hypertriglyceridaemia causing acute pancreatitis 3:
- poorly controlled diabetes
- obesity
- personal history of hypertriglyceridaemia
- familial hypertriglyceridaemia
- personal history of pancreatitis
Clinical presentation
The presentation will be similar to other causes of acute pancreatitis, the cardinal feature being constant, intense abdominal pain which can radiate to the upper back or left shoulder. Peripheral signs of hypertriglyceridaemia may be present such as xanthomata and xanthelasma 3.
Pathology
The exact mechanism of how hypertriglyceridaemia causes pancreatitis is unknown 3. One theory is that hyperviscosity of blood in the pancreatic capillaries caused by hypertriglyceridaemia causes ischaemia and injury to the pancreas 3. Generally the level of triglycerides must be significantly elevated to above 11 mmol/L (or 1,000 mg/dL) to be capable of causing pancreatitis.
Aetiology
Both primary and secondary causes of hypertriglyceridaemia-induced pancreatitis exist 3:
- primary
- inherited defects in proteins involved in fat metabolism (e.g. lipoprotein lipase deficiency or apo C-II protein deficiency)
- secondary:
- poorly controlled diabetes (insulin resistance causes increased levels of triglycerides)
- drugs (e.g. oestrogen)
- pregnancy
- alcohol use
- hypothyroidism
Radiographic features
There are no specific findings in hypertriglyceridaemia-induced pancreatitis, the main role of imaging is to exclude other causes of pancreatitis (e.g. gallstones) and investigate complications relating to pancreatitis. Hepatomegaly and steatosis may be present due to fatty infiltration 3.
Treatment and prognosis
Plasmapheresis or intravenous insulin (in the presence concurrent hyperglycaemia) are often used in the treatment of hypertriglyceridaemia-induced pancreatitis 3. Lipid-lowering therapy and a proper diet should also be commenced to lower the risk of future pancreatitis and cardiovascular disease 3.