BACKGROUND: Hypertriglyceridaemia is an oft-forgotten cause of acute pancreatitis (AP), which can lead to delay in appropriate therapy, increased morbidity, and recurrent pancreatitis. Secondary hypertriglyceridaemia can be a result of uncontrolled diabetes mellitus, acute alcohol ingestion, and hypothyroidism.1 There are no clear guidelines on the management, and there is limited evidence supporting current treatment methods of insulin infusion and apheresis.
OBJECTIVE: A two-centre retrospective audit was conducted of presentations with AP over a three-year period, and management of those with elevated triglyceride levels (defined as ≥6mmol/L) was reviewed.
RESULTS: There were 1628 presentations of AP between 1st January 2016 to 31st December 2018 to either Gold Coast University Hospital or Robina Hospital, Australia. 27 of these presentations (1.64%) from 20 patients are attributed to hypertriglyceridaemia due to recorded peak serum triglyceride level ≥6mmol/L during the admission (mean 67.4mmol/L). However, aetiology of 18.5% presentations was documented in electronic records as AP either due to acute alcohol binge or no cause listed, despite elevated triglyceride levels.
92.6% required admission into hospital with an average of 11.5 day stay. Of those those admitted, 36% had insulin infusion, 12% had apheresis, and 28% required intensive care admission. Surprisingly, only 84% were discharged on either statins and/or fibrates. There was a high recurrence rate, as 72% had either prior or future hypertriglyceridaemia-induced AP.
Pre-existing diabetes mellitus affected 44% of patients, however HbA1c was measured in only 63.6% of these presentations. Thyroid function tests were measured in 36%, with 11.1% yielding an abnormal result. Endocrinologist opinion was sought in 51.8% of presentations.
CONCLUSION: It can be derived that hypertriglyceridaemia-induced AP, whilst uncommon, is undertreated, undermanaged, and specialist opinion is often not sought. Patients are thus at risk of recurrent pancreatitis, which results in increased morbidity with recurrent abdominal pain and further hospital presentations.