SUN-862 - Management of Recurrent Hypertriglyceridemia-Induced Acute Pancreatitis

Introduction:
Hypertriglyceridemia affects ~7% of the population and is a recognized cause of acute pancreatitis after alcohol and gallstones. ¹ Triglyceride (TG) levels >1,000–2,000 mg/dL significantly increase risk,² and even levels >177 mg/dL are associated with pancreatitis, especially with genetic susceptibility.³˒⁴ Early recognition of hypertriglyceridemia-induced pancreatitis (HTGP) is essential. This is a case of a non-diabetic woman with severe hypertriglyceridemia who improved rapidly with insulin infusion.

Case Presentation:
A 37-year-old female with prior pancreatitis in 2016 and 2021 presented with 3 days of burning epigastric pain radiating to the back and nausea. She had discontinued fenofibrate after her 2021 admission and denied alcohol or gallstone as well as thyroid and kidney problem history. Previous TG levels were 5,696 mg/dL (2016) and 1,479 mg/dL (2021), with CT findings consistent with pancreatitis.
At this presentation, vitals were stable. Labs showed lipase 1,114 U/L, TG 2,042 mg/dL, and WBC 14.4K. CT abdomen demonstrated inflammatory changes of the pancreatic tail, consistent with acute pancreatitis. She was admitted to the ICU and treated with IV fluids, insulin infusion, analgesics, and antiemetics. Within 24 hours, TG decreased to 285 mg/dL and lipase to 448 U/L without hypoglycemia. Symptoms resolved, and she was discharged on day 4 with fenofibrate 48 mg nightly. At 8-day follow-up, she reported no recurrent pain and was medication-compliant.

Discussion:
Management of HTGP includes aggressive fluids, pain control, nutritional support, and rapid TG lowering. ² Insulin enhances lipoprotein lipase activity, accelerating TG clearance and improving outcomes. ⁵˒⁶ Long-term prevention requires lifestyle changes and pharmacologic therapy; fibrates reduce TG by up to 50% and raise HDL by ~20%. ⁸˒⁹ Plasmapheresis offers faster TG reduction but is costly and carries more adverse events. ¹¹ LMWH plus insulin may reduce early organ failure but has not shown consistent superiority over insulin monotherapy. ¹² Emerging agents targeting apolipoprotein C-III, such as plozasiran, may prevent recurrence in high-risk patients. ¹³Further studies are needed to establish the insulin therapy without complications in non-diabetic hypertriglyceridemia-induced acute pancreatitis.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*