A Case of Hypertriglyceridemic Pancreatitis during Pregnancy in a Patient with Type 2 Diabetes

Abstract

The patient was an obese 20-year-old pregnant female who developed abdominal pain at 28 weeks of gestation. She was diagnosed with acute pancreatitis based on an elevated serum amylase level, hypertriglyceridemia, hyperglycemia and pancreatic enlargement detected on abdominal ultrasound. Her condition did not improve with primary treatment, and intrauterine fetal death was confirmed. A cesarean section was performed on the third hospital day. Furthermore, plasma exchange was performed in addition to the continuous administration of heparin and insulin to treat the hypertriglyceridemia. After these treatments, both the laboratory and clinical findings showed improvements. The serum triglyceride level is usually elevated during normal pregnancies due to the low lipoprotein lipase activity. However, the elevation is more obvious during pregnancy complicated by glucose metabolism disorders. Considering the high HbA1c level (HbA1c 9.8 %) observed at the onset of pancreatitis in this patient, acute pancreatitis presumably occurred as a result of existent hypertriglyceridemia induced by an undiagnosed underlying glucose metabolism disorder. The acute pancreatitis and fetal death could have been prevented with the diagnosis and management of the glucose metabolism disorder during the early stage of pregnancy.