Yasir Furkan ÇAĞIN, Yüksel SEÇKİN, Yılmaz BİLGİÇ, OĞUZHAN YILDIRIM, Muhammed YALÇIN, Murat ALADAĞ

Tip I diabetes mellitus ve hipotiroidiye bağlı çok şiddetli hipertrigliseridemi nedenli şiddetli akut pankreatit: bir olgu sunumu

Hiperlipidemik pankreatit, şiddetli hipertrigliseridemi sonucunda oluş- maktadır. Tüm akut pankreatit hastalarının yaklaşık olarak %1-4ünü oluşturmaktadır. Hipertrigliseridemiye bağlı akut pankreatitte hala stan- dart bir tedavi yoktur. Son yıllarda şiddetli hipertrigliseridemiye bağlı akut pankreatitli standart medikal tedaviye dirençli hastalarda lipid afe- rez uygulaması giderek artmaktadır. Bu olgu ile; şiddetli hiperlipidemiye bağlı akut pankreatit tedavisi için klinik olayların gelişimi ve lipid aferez tedavisi sunulmuştur. 23 yaşında, bekar, bayan hasta şiddetli epigast- rik ağrı ve kusma ile acil servise başvurdu. Daha önce kötü kontrollü tip I diabetes mellitus ve total tiroidektomi sonrası gelişen hipotiroidisi varken, alkol alım öyküsü yoktu. Biliyer görüntülemesi normal idi. Fizik muayenede bilinç konfüze, epigastrik hassasiyeti ve anazarka tarzında yaygın ödemi mevcut idi. Laboratuvar tetkiklerinde ciddi hipertriglise- ridemi (10.200 mg/dL, normal aralık: 30-150) vardı. Serum amilaz ve lipaz değerleri sırasıyla 1.410 ve 4.535 U/L, kan glukozu 567 mg/dL ve tiroit stimule edici hormon >100 µIU/mL idi. Abdominal bilgisayarlı tomografisinde akut pankreatit ile uyumlu görüntü, peripankreatik kol- leksiyon, plevral ve perikardiyal effüzyon izlendi. Hastaya şiddetli hipert- rigliseridemiye sekonder akut pankreatit tanısı kondu. Hastaya insülin, heparin ve levotiroksin tedavisine ek olarak üç seans aferez uygulandı. Hasta yatışının 10. gününde laboratuvar tetkiklerinin seviyeleri şöyle idi. Trigliserit: 322, total kolesterol: 164 mg/dL, serum glukoz 168 mg/ dLye geriledi. Serum amilaz, lipaz normal, tiroit stimule edici hormon: 91 µIU/mL idi. Hastanın klinik tablosunda da dramatik düzelme oldu. Sonuç olarak şiddetli hipertrigliseridemiye bağlı akut pankreatitte aferez tedavisi faydalı ve hayat kurtarıcı olabilir. Klinik tablodaki iyileşmeyi hız- landırmakta ve tama yakın bir tedavi sağlamaktadır

Severe acute pancreatitis due to very severe hypertriglyceridemia related type I diabetes mellitus, and hypothyroidism: a case report

Hyperlipidemic pancreatitis is caused by severe hypertriglyceridemia and comprises about 1-4% of all acute pancreatitis patients. There are no standardized treatment protocols, though an increased use of lipid apheresis has been reported over the last several years. In this case report, we describe the onset of clinical events and the use of lipid apheresis to treat acute pancreatitis due to severe hypertriglyceridemia. A 23 years-old female was admitted to the emergency room for severe epigastric pain and vomiting. The patient had a history of poorly con- trolled type 1 diabetes mellitus, and hypothyroidism that developed following thyroidectomy. There was no history of alcohol consump- tion. Biliary imaging was normal. Physical examination showed that the patient exhibitied confused consciousness, epigastric tenderness and symptoms of anasarca edema. Laboratory investigation revealed marked hypertriglyceridemia (10.200 mg/dL; range: 0-149). Serum am- ylase and lipase were elevated at 1.410 U/L (range: 25-125) and 4535 U/L (range:8-78), respectively. Serum glucose and thyroid-stimulating hormone were elevated at 567 mg/dl (range: 70-105), and 100>µIU/ mL (0.34-5.6), respectively. A computerized tomography scan of the abdomen revealed a clinical picture compatible with acute pancreatic and peripancreatic collection, and pleural and pericardial effusion. The patient was diagnosed with acute pancreatitis secondary to severe hy- pertriglyceridemia and was successfully treated with three sessions of lipid apheresis, in addition to insulin, heparin and levothyroxine thera- py. Following a 10 day hospitalization, the level of lipids, lipoproteins and serum glucose were as follows: triglycerides 322 mg/dL, total cho- lesterol 164 mg/dL, and serum glucose 168 mg/dL. Serum amylase and lipase were normal. Thyroid-stimulating hormone was 91µIU/mL. The patient improved dramatically. Apherisis therapy may be beneficial and life-saving in cases of acute pancreatitis due to severe hypertriglyceri- demia. The patient described in this case report improved rapidly and the recovery was complete.

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