Hypertriglyceridemia-induced pancreatitis is a rare, but serious, complication of pregnancy. We report a case of acute pancreatitis associated with type V hyperlipoproteinemia in pregnancy. A 36-year-old primigravida was admitted at 16 weeks of gestation with severe abdominal pain. Chemical analysis showed high serum pancreatic enzymes and very high serum triglyceride. Abdominal magnetic resonance imaging (MRI) showed diffuse swelling of the pancreas and a peripancreatic fluid collection. A diagnosis of acute pancreatitis with type V hyperlipoproteinemia was made. She recovered from the acute pancreatitis with conservative management and the serum triglyceride decreased rapidly with dietary restriction of fat, insulin/glucose, fenofibrate, and omega-3. We review the management of hypertriglyceridemia-induced acute pancreatitis in pregnancy.
Abdominal Pain ; Adult ; Fenofibrate ; Humans ; Hyperlipoproteinemia Type V ; Hypertriglyceridemia ; Magnetic Resonance Imaging ; Pancreas ; Pancreatitis ; Pregnancy

The hyperlipoproteinemias are the disturbance of lipid transport resulted from accelerated synthesis or retarded degradation of lipoproteins that transport cholesterol and trigycerides through plasma. These diseases are classified as type I, type IIa, type IIb, type III, type IV, type V, and hyper- -lipoproteinemia by lipoprotein phenotype. Type V hyperlipoproteinemia is uncommon in childhood and characterized by elevation of triglyceride levels due to increases in both VLDL and chylomicrons and lipoprotein electrophoresis shows increased pre- , , and chylomicron bands. We experienced a case of hyperlipoproteinemia type V in a 12 year old male who presented no specific signs and symptoms. So, we report a case of hyperlipoproteinemia type V with brief review of the literatures.
Child ; Cholesterol ; Chylomicrons ; Electrophoresis ; Humans ; Hyperlipoproteinemia Type V* ; Hyperlipoproteinemias ; Lipoproteins ; Male ; Phenotype ; Plasma ; Triglycerides

We report a case of type V hyperlipoproteinemia and xanthoma eruptivum associated with diabetes mellitus in a 12-year-old female. She had diffuse erythematous yellowish papules on the extremities and trunk with itching. The laboratory findings showed increased serum blood glucose, cholesterol and triglyceride, increasing pre- and chylomicron bands on electrophoresis of lipoprotein. The biopsy specimen of an erythematous yellowish colored papule on the trunk showed characteristic findings of xanthoma.
Biopsy ; Blood Glucose ; Child ; Cholesterol ; Diabetes Mellitus* ; Electrophoresis ; Extremities ; Female ; Humans ; Hyperlipoproteinemia Type V* ; Lipoproteins ; Pruritus ; Triglycerides ; Xanthomatosis*

Type V hyperlipoproteinemia result from the accumulation of trglyceride(TG)-rich lipoproteins, very low density lipoprotein(VLDL), and chylomicrons. A 53-year old woman has showed asmptomatic, yellowish patches on tie palms and eyelids and papules on the knees with various types of xanthoma including xanthelasma palpebraum, xanthoma striatum palmare, anrl nonspecific papular xanthoma. The blood chemistry revealed a marked elevation of cholesterol and TG, and lipoprotein electrophoresis showed fasting chylomicronemia, prep-b and b-band, On histologic studies, typical foam cells were shown.
Chemistry ; Cholesterol ; Chylomicrons ; Electrophoresis ; Eyelids ; Fasting ; Female ; Foam Cells ; Humans ; Hyperlipoproteinemia Type V* ; Knee ; Lipoproteins ; Middle Aged ; Xanthomatosis

We report a case of type V hyperlipoproteinemia with xanthoma eruptivum in a 30-year-old male. He had diffuse erythematous yellowish papules on both extremities and the buttock. The laboratory findings showed the increased cholesterol and the triglyceride. Serum electrophoresis showed an increase in pre-beta and chylomicron, suggesting type V hyperlipoproteinemia. The biopsy specimen of an erythematous yellowish colored papule on the right knee showed many aggregates of foam cells without Touton giant cells.
Adult ; Biopsy ; Buttocks ; Cholesterol ; Electrophoresis ; Extremities ; Foam Cells ; Giant Cells ; Humans ; Hyperlipoproteinemia Type V* ; Knee ; Male ; Triglycerides ; Xanthomatosis*

We report two cases of type V hyperlipoproteinemia and eruptive xanthomas associated with diabetes mellitus in a 44-year-old woman and a 25-year-old woman. They had asymptomatic, diffuse, erythematous yellowish papules on the extremities and buttocks. The laboratory studies showed increased serum blood glucose, total cholesterol, triglyceride, increasing pre-β and chylomicron bands on electrophoresis of lipoprotein. Histopathologic findings of erythematous yellowish papules on the thigh and buttock revealed aggregation of foam cells in the dermis. They have been treated with diet control, hypoglycemic agent (gliclazide) and hypolipidemic drug (gemfibrozil), and are under continued supervision.
Adult ; Blood Glucose ; Buttocks ; Cholesterol ; Dermis ; Diabetes Mellitus* ; Diet ; Electrophoresis ; Extremities ; Female ; Foam Cells ; Humans ; Hyperlipoproteinemia Type V* ; Lipoproteins ; Organization and Administration ; Thigh ; Triglycerides ; Xanthomatosis*

We report a case of type V hyperlipoproteinemia with xanthoma eruptivum associated with diabetes mellitus. An 18-year-old female patient presented with multiple, erythematous papules on the trunk, buttocks, and both extremities and multiple orange-yellow colored, conglomerated nodules on the elbows and knees. Laboratory examination showed increased serum blood glucose, cholesterol and triglyceride. Lipoprotein electrophoresis showed increased pre-beta and chylomicron bands. Analysis of lipoprotein revealed increase of very low density lipoprotein (VLDL) and triglyceride levels in the plasma. A skin biopsy from the papule on the trunk revealed a xanthoma. We diagnosed the patient as type V hyperlipoproteinemia. After 10 months of treatment with insulin and gemfibrozil, the serum levels of cholesterol and triglyceride were reduced to normal level. The skin lesions showed marked improvement without scar.
Adolescent ; Biopsy ; Blood Glucose ; Buttocks ; Cholesterol ; Cicatrix ; Diabetes Mellitus ; Elbow ; Electrophoresis ; Extremities ; Female ; Gemfibrozil ; Humans ; Hyperlipoproteinemia Type V* ; Insulin ; Knee ; Lipoproteins ; Plasma ; Skin ; Triglycerides ; Xanthomatosis*

OBJECTIVEThe aim of this study was to evaluate the efficacy and safety of combination therapy with simvastatin and fenofibrate in patients with combined hyperlipidemia.

METHODSA total of 221 patients with combined hyperlipidemia were randomly assigned to receive 10 mg simvastatin (n = 72) or 200 mg fenofibrate (n = 68), or a combination of 10 mg simvastatin + 200 mg fenofibrate (n = 81) for 6 months. Lipid profiles, physical and laboratory investigations for adverse effects were assessed.

RESULTS(1) Combination treatment were more effective in normalizing lipid profile than any monotherapy. Serum TC, LDL-C, and TG were reduced by 30%, 37% and 56% respectively, whilst HDL-C significantly increased by 24% (all P < 0.01). The improvement in TG and HDL-C achieved by combination treatment was superior to fenofibrate or simvastatin alone. (2) The success rate of TC, LDL-C and TG control in the combination therapy group were 51%, 55% and 61% respectively, with an overall success rate (all three together) of 45%, which was superior to either drug given as monotherapy. (3) All treatments were well tolerated with no increase in adverse events for combination therapy versus monotherapy.

CONCLUSIONThe results of this study demonstrated that combination therapy with fenofibrate (200 mg/day) and low-dose simvastatin (10 mg/day) is more effective than monotherapy in patients with combined hyperlipidemia, and is generally safe and well tolerated.

Drug Therapy, Combination ; Female ; Fenofibrate ; administration & dosage ; adverse effects ; therapeutic use ; Humans ; Hyperlipoproteinemia Type V ; drug therapy ; Hypolipidemic Agents ; administration & dosage ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Simvastatin ; administration & dosage ; adverse effects ; therapeutic use

Primary hypothyroidism and type 2 diabetes are both typically associated with the increased level of triglycerides. To date, there have been only a few case reports of type 2 diabetes patients with both type V hyperlipoproteinemia and eruptive xanthomas, but there have been no reports of hypothyroidism patients associated with eruptive xanthomas. We report here on a case of a 48-yr old female patient who was diagnosed with type 2 diabetes and primary hypothyroidism associated with both type V hyperlipoproteinemia and eruptive xanthomas. We found rouleaux formation of RBCs in peripheral blood smear, elevated TSH, and low free T4 level, and dyslipidemia (total cholesterol 18.1 mM/L, triglyceride 61.64 mM/L, HDL 3.0 mM/L, and LDL 2.54 mM/L). She has taken fenofibrate, levothyroxine, and oral hypoglycemic agent for 4 months. After treatment, both TSH level and lipid concentration returned to normal range, and her yellowish skin nodules have also disappeared.
Antilipemic Agents/therapeutic use ; Diabetes Mellitus, Type 2/blood/*complications/drug therapy ; Erythrocyte Aggregation ; Female ; Humans ; Hyperlipidemia/blood ; Hyperlipoproteinemia Type V/blood/*complications/drug therapy ; Hypoglycemic Agents/therapeutic use ; Hypothyroidism/blood/*complications/drug therapy ; Middle Aged ; Procetofen/therapeutic use ; Research Support, Non-U.S. Gov't ; Skin Diseases/blood/complications/drug therapy ; Thyrotropin/blood/therapeutic use ; Thyroxine/blood ; Treatment Outcome ; Xanthomatosis/blood/*complications/drug therapy