Severe Hypertriglyceridemia-Induced Acute Pancreatitis in Pregnancy: A Case Report and Review of Management
https://doi.org/10.15605/jafes.041.S1
- Author:
Shaleela Mohd Esha
1
;
Chua Yi Jiang
1
;
Wong Hui Chin
1
;
Ooi Xin Yi
1
;
Yong Sy Liang
1
Author Information
1. Hospital Tengku Ampuan Rahimah
- Publication Type:Journal Article
- MeSH:
Female;
Pregnancy;
Acute Disease;
Pancreatitis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):65-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Severe hypertriglyceridemia during pregnancy is a rare
yet potentially life-threatening disorder. It is frequently
linked to acute pancreatitis and poses considerable risks
for both maternal and fetal morbidity.
Case:We report a 35-year-old G4P3 female at 33 + 6 weeks
gestation with underlying type 2 diabetes mellitus who
presented with acute abdominal pain, nausea, vomiting,
and poor oral intake, initially mistaken for preterm labor
and sepsis. Further evaluation revealed profound hypertriglyceridemia (triglycerides 79.1 mmol/L) with markedly
elevated total cholesterol (>32 mmol/L) and raised serum
amylase, consistent with hypertriglyceridemia-induced
acute pancreatitis. She was managed in a multidisciplinary
setting with intravenous insulin infusion, dextrose supplementation, aggressive fluid resuscitation, and empiric
antibiotics. Due to clinical deterioration and ongoing risk of
maternal complications, she underwent emergency lower
segment caesarean section and exploratory laparotomy
at 34 weeks of gestation. Intraoperative findings included
inflammatory intra-abdominal fluid and a bulky pancreas,
supporting the diagnosis. Rapid biochemical improvement was observed following treatment, with triglyceride levels
decreasing by approximately 70% within 24 hours (79.1–
24.0 mmol/L) and achieving >90% reduction over 10 days.
Postpartum management included initiation of omega-3
fatty acids, fibrate, and statin therapy, resulting in sustained
lipid control. Ophthalmologic examination demonstrated
lipemia retinalis, further confirming severe dyslipidemia.
Conclusion:This case highlights the importance of early recognition of
severe hypertriglyceridemia in pregnancy, particularly in
patients with metabolic risk factors such as diabetes. Prompt
initiation of insulin therapy can achieve rapid triglyceride
reduction and may obviate the need for plasmapheresis in
selected cases. Delivery should be considered in the setting
of maternal instability. Long-term lipid management
postpartum is essential for preventing recurrence and
reducing future metabolic risk. A multidisciplinary
approach remains critical in optimizing both maternal and
fetal outcomes in this rare but serious condition.
- Full text:2026080316371883537EP_A083.pdf
