Divergent Clinical Manifestations of Severe Hypertriglyceridemia: A Case Series
https://doi.org/10.15605/jafes.041.S1
- Author:
Shinye Eng
1
;
Rabeah Md Zuki
1
Author Information
1. Medical Department, Hospital Sultan Abdul Halim
- Publication Type:Journal Article
- MeSH:
Hypertriglyceridemia
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):53-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Severe hypertriglyceridemia increases the risk of pancreatitis and cardiovascular events. Therapies such as insulin,
heparin, and plasmapheresis have been used. We present
two cases of severe hypertriglyceridemia with distinct
clinical presentations and management approaches.
Cases:We first describe a 26-year-old female with hypertriglyceridemia who presented with acute epigastric pain
radiating to the back. She had a prior admission 3 years
earlier for acute pancreatitis complicated by acute
respiratory distress syndrome, during which severe hypertriglyceridemia was diagnosed (triglycerides 13.5 mmol/L)
but was not treated at that time. She had no history of alcohol
use, diabetes, or family history of hypercholesterolemia.
On admission, she was hemodynamically stable. Serum
triglycerides were markedly elevated at 32.3 mmol/L, total
cholesterol was 8.6 mmol/L, and non-HDL cholesterol
was 8.1 mmol/L. Serum amylase was elevated (1,606 U/L).
Computed tomography (CT) abdomen demonstrated acute
interstitial pancreatitis with peripancreatic fluid collection.
She was managed conservatively with intravenous fluids
and bowel rest. Triglycerides declined rapidly to 6.1
mmol/L by day 8 without intravenous insulin therapy. She
was discharged on lipid-lowering therapy. The second case involved a 57-year-old female with underlying hypertension, dyslipidemia, and poorly controlled
diabetes mellitus who had not been on treatment for 3
years and presented with acute left-sided weakness. Brain
CT confirmed a right cerebral infarction. Laboratory tests
revealed triglycerides of 23.2 mmol/L, total cholesterol 9.9
mmol/L, non-HDL cholesterol 9.8 mmol/L, and hemoglobin
A1c 11.2%. Intravenous insulin therapy was initiated,
resulting in a progressive triglyceride reduction (Day 2: 18.7
mmol/L; Day 3: 13.1 mmol/L; Day 4: 11.0 mmol/L; Day 6: 6.9
mmol/L; Day 8: 4.2 mmol/L). Fenofibrate and high-intensity
rosuvastatin were commenced, and glycemic control was
optimized before discharge
Conclusion:Severe hypertriglyceridemia may present variably, from
acute pancreatitis to ischemic stroke. Individualized
management led to a successful reduction of triglycerides.
Early recognition, tailored therapy, and ongoing metabolic
care are essential to reduce recurrence and long-term
complications.
- Full text:2026073016002300031EP_A062.pdf
