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Abstract
Acute pancreatitis causes include alcoholism, gall stones and drugs, but rarely it can be caused by severe hypertriglyceridemia. Hypertriglyceridemia is usually multifactorial. The mechanism of hypertriglyceridemia may be due to genetic factors, increased production and/or impaired clearance of TRLP (Triglyceride-Rich Protein). Familial hypertriglyceridemia is an autosomal dominant disorder associated with moderate elevations in the serum triglyceride (200-500mg/dl). Pregnancy can cause an exponential rise in triglyceride levels (>1000mg/dl) in patients having mutations with the lipoprotein lipase gene. HIAP (Hypertriglyceridemia-Induced Acute Pancreatitis) accounts for 4% of all cases of acute pancreatitis in pregnancy. Though rare, hypertriglyceridemia-induced pancreatitis may lead to maternal and fetal complications. A multi-disciplinary team approach is very crucial as maternal and fetal needs must be addressed.
HTG (Hypertriglyceridemia) is one of the rare causes of acute pancreatitis in pregnancy. Hypertriglyceridemia in pregnancy is multifactorial; among them familial chylomicronemia syndrome is the most severe form.[1] Delay in recognition and proper management, is associated with high maternal and fetal mortality rates.
As the duration of pregnancy increases the risk of pancreatitis associated with HTG also rises to 19% in first trimester, 26% in the 2nd trimester, 53% in the 3rd trimester, and 2% in the post-partum period.[2]
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References
- Jaafar B, Chaaya JA, Ammar S, et al. Acute pancreatitis in pregnancy and familial chylomicronemia syndrome: Case report and literature review. Metab Target Organ Damage 2023;3:21.
- Ducarme G, Maire F, Chatel P, et al. Acute pancreatitis during pregnancy: a review. J Perinatol 2014; 34:87-94.
- Madden N, Kamal N, Friedman J, et al. Obstetrical management of severe hypertriglyceridemia in pregnancy: a case report. AJP Rep 2024;14(4):e244-9.
- Wong B, Ooi TC, Keely E. Severe gestational hypertriglyceridemia: a practical approach for clinicians. Obstet Med 2015;8(4):158-67.
- Cruciat G, Nemeti G, Goidescu L, et al. Hypertriglyceridemia triggered acute pancreatitis in pregnancy-diagnostic approach, management and follow-up care. Lipids Health Dis 2020;19(1):2.
- Korn ED. Clearing factor, a heparin-activated lipoprotein lipase. II. Substrate specificity and activation of coconut oil. J Biol Chem 1955;215(1):15-26.
- Yen JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher 2003;18(4):181-5.
References
Jaafar B, Chaaya JA, Ammar S, et al. Acute pancreatitis in pregnancy and familial chylomicronemia syndrome: Case report and literature review. Metab Target Organ Damage 2023;3:21.
Ducarme G, Maire F, Chatel P, et al. Acute pancreatitis during pregnancy: a review. J Perinatol 2014; 34:87-94.
Madden N, Kamal N, Friedman J, et al. Obstetrical management of severe hypertriglyceridemia in pregnancy: a case report. AJP Rep 2024;14(4):e244-9.
Wong B, Ooi TC, Keely E. Severe gestational hypertriglyceridemia: a practical approach for clinicians. Obstet Med 2015;8(4):158-67.
Cruciat G, Nemeti G, Goidescu L, et al. Hypertriglyceridemia triggered acute pancreatitis in pregnancy-diagnostic approach, management and follow-up care. Lipids Health Dis 2020;19(1):2.
Korn ED. Clearing factor, a heparin-activated lipoprotein lipase. II. Substrate specificity and activation of coconut oil. J Biol Chem 1955;215(1):15-26.
Yen JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher 2003;18(4):181-5.