Aralik 2015
Tip I diabetes mellitus ve hipotiroidiye bagli çok siddetli hipertrigliseridemi nedenli siddetli akut pankreatit: bir olgu sunumu
Severe acute pancreatitis due to very severe hypertriglyceridemia related type I diabetes mellitus, and hypothyroidism: a case report
- Ana Sayfa
- Sayılar
- Aralik 2015
- Tip I diabetes mellitus ve hipotiroidiye bagli çok siddetli hipertrigliseridemi nedenli siddetli akut pankreatit: bir olgu sunumu...
Özet
Hiperlipidemik pankreatit, siddetli hipertrigliseridemi sonucunda olusmaktadir. Tüm akut pankreatit hastalarinin yaklasik olarak %1-4’ünü olusturmaktadir. Hipertrigliseridemiye bagli akut pankreatitte hala standart bir tedavi yoktur. Son yillarda siddetli hipertrigliseridemiye bagli akut pankreatitli standart medikal tedaviye dirençli hastalarda lipid aferez uygulamasi giderek artmaktadir. Bu olgu ile; siddetli hiperlipidemiye bagli akut pankreatit tedavisi için klinik olaylarin gelisimi ve lipid aferez tedavisi sunulmustur. 23 yasinda, bekar, bayan hasta siddetli epigastrik agri ve kusma ile acil servise basvurdu. Daha önce kötü kontrollü tip I diabetes mellitus ve total tiroidektomi sonrasi gelisen hipotiroidisi varken, alkol alim öyküsü yoktu. Biliyer görüntülemesi normal idi. Fizik muayenede bilinç konfüze, epigastrik hassasiyeti ve anazarka tarzinda yaygin ödemi mevcut idi. Laboratuvar tetkiklerinde ciddi hipertrigliseridemi (10.200 mg/dL, normal aralik: 30-150) vardi. Serum amilaz ve lipaz degerleri sirasiyla 1.410 ve 4.535 U/L, kan glukozu 567 mg/dL ve tiroit stimule edici hormon >100 μIU/mL idi. Abdominal bilgisayarli tomografisinde akut pankreatit ile uyumlu görüntü, peripankreatik kolleksiyon, plevral ve perikardiyal effüzyon izlendi. Hastaya siddetli hipertrigliseridemiye sekonder akut pankreatit tanisi kondu. Hastaya insülin, heparin ve levotiroksin tedavisine ek olarak üç seans aferez uygulandi. Hasta yatisinin 10. gününde laboratuvar tetkiklerinin seviyeleri söyle idi. Trigliserit: 322, total kolesterol: 164 mg/dL, serum glukoz 168 mg/ dL’ye geriledi. Serum amilaz, lipaz normal, tiroit stimule edici hormon: 91 μIU/mL idi. Hastanin klinik tablosunda da dramatik düzelme oldu. Sonuç olarak siddetli hipertrigliseridemiye bagli akut pankreatitte aferez tedavisi faydali ve hayat kurtarici olabilir. Klinik tablodaki iyilesmeyi hizlandirmakta ve tama yakin bir tedavi saglamaktadir
Abstract
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 controlled type 1 diabetes mellitus, and hypothyroidism that developed following thyroidectomy. There was no history of alcohol consumption. 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 amylase 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 hypertriglyceridemia and was successfully treated with three sessions of lipid apheresis, in addition to insulin, heparin and levothyroxine therapy. Following a 10 day hospitalization, the level of lipids, lipoproteins and serum glucose were as follows: triglycerides 322 mg/dL, total cholesterol 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 hypertriglyceridemia. The patient described in this case report improved rapidly and the recovery was complete
