Endocrinology and Metabolism

Case Reports

Ketoacidosis with Hypertriglyceridemia-Induced Pancreatitis in a Patient with Gestational Diabetes: A Case Report.: Hyun Hee Chung, Sang Hyun Park, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee; Endocrinol Metab. 2012;27(1):89-92. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.89

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Hypertriglyceridemia-induced acute pancreatitis in pregnancy is not a common complication. Moreover, ketoacidosis in gestational diabetes occurs rarely. Here we report a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes that was successfully treated with insulin and supportive care. In this case, a 36-year-old woman (at 32 weeks' gestation) was diagnosed with gestational diabetes 4 weeks prior, but did not have well controlled blood sugar. She complained of severe epigastric pain concomitant with nausea and vomiting. Radiology and laboratory tests found hypertriglyceridemia (1,996 mg/dL), acute pancreatitis, and ketoacidosis with absence of fetal deceleration on a non-stress test. The patient's condition improved with insulin therapy and fluid replacement. To our knowledge, this is the first report of a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes.

Citations

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Acute Pancreatitis in a Pregnant Patient with Type IV Hyperlipoproteinemia
Sang Ho Lee, Jae Hyuck Jun, Young Seok Doh, Ji Woong Jang, Sae Hee Kim, Il Hyun Baek, Sung Hee Jung
The Korean Journal of Pancreas and Biliary Tract.2019; 24(2): 73. CrossRef
Hypertriglyceridemia-Induced Acute Pancreatitis
Jin Myung Park
The Korean Journal of Pancreas and Biliary Tract.2017; 22(4): 158. CrossRef
Cheese-like Material in the Heart: An Autopsy Case Report of Severe Hypertriglyceridemia in Diabetic Ketoacidosis Patient
Joo Young Na, Eun Hee Kim, Bon Young Koo, Ik Jo Chung, Byung Ha Choi, Nak Eun Chung
Korean Journal of Legal Medicine.2013; 37(4): 212. CrossRef

A Case of Parathyroid Adenoma Manifested as Acute Pancreatitis Accompanied Subclinical Cushing's Syndrome due to an Adrenal Adenoma.: Sang Hoon Leigh, Dong Sik Jo, Si Woo Kim, Yu Jin Jo, Sung Chul Cha, Jung Kwon Kim, Sun Hee Park, Hang Ji Kang; J Korean Endocr Soc. 2007;22(5):353-358. Published online October 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.5.353

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Abstract PDF: The manifestation of primary hyperparathyroidism by acute pancreatitis is a rare event. Furthermore, an asymptomatic adrenal mass may incidentally be detected by abdominal computed tomography. A mass that autonomously secretes glucocorticoid without any symptom is called subclinical Cushing's syndrome. In this study, we report a rare case of a parathyroid adenoma manifested as acute pancreatitis accompanied with subclinical Cushing's syndrome due to an incidental adrenal mass. A 47-year-old female patient presented with acute pancreatitis and hypercalcemia had a parathyroid mass detected by neck ultrasonography and a Tc(99m)-sestamibi scan. An abdominal computed tomography revealed a 3.1 x 4.3 cm mass which was detected in the left adrenal gland. The hormonal levels showed a high serum cortisol level, low ACTH level, and a high 24 h urine free cortisol level. The low and high dose dexamethasone suppression test showed no suppression. The parathyroid and adrenal masses were resected and the laboratory findings were normalized.

A Case of Acromegaly with Diabetic Ketoacidosis and Hypertriglyceridemia-Induced Acute Pancreatitis .: Choon Young Lee, Moon Kyu Lee, Sun Young Lee, Sung No Hong, Hyung Hoon Kim, Bo Hyun Kang, Han Wook Kang, Byung Wan Lee, Yu Jeong Park, Yong Ki Min, Myung Shik Lee, Kwang Won Kim, Jong Hyun Kim; J Korean Endocr Soc. 2002;17(1):110-116. Published online February 1, 2002

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Abstract PDF: Secondary diabetes mellitus caused by increased growth hormone secretion (GH) has well been known. There is a close association between glucose intolerance and GH secretion, and increased GH level itself probably worsens the blood glucose control and lipid profile by increasing glycogenolysis and / or gluconeogenesis and by suppressing lipase activity. We report a case of acromegaly with diabetic ketoacidosis as and hypertriglyceridemia-induced acute pancreatitis. A 38 year old male, previously diagnosed to have acromegaly and diabetes, presented with nausea, vomiting, diffuse abdominal pain and altered mentality. There was no history of drug or alcohol consumption, blood gas analysis showed severe acidosis and urinanalysis for ketone was positive. His serum blood glucose, amylase and lipase levels were 494 mg/dL, 331 U/L, and 1288 U/L, respectively (reference values: 70~110 mg/dL, 13~100 U/L and 13~190 U/L, respectively). The patient was diagnosed as having diabetic ketoacidosis and acute pancreatitis. With the serum concentration of triglyceride being 1488 mg/dL and the absence of any obvious precipitating factors, we considered hypertriglyceridemia to be the cause of acute pancreatitis. He was treated with continuous intravenous insulin infusion, lipid lowering agent, and fluid replacement. After conservative management, general condition gradually improved and his serum amylase, lipase and triglyceride levels were all normalized. GH level was not suppressed under 2 ng/mL during oral glucose loading test, and basal GH and IGF levels were 231 ng/mL and 29.5 ng/mL, respectively. Sella MRI showed a 3.7 cm sized pituitary mass. On the 55th day of admission, transsphenoidal surgery was performed. In immunohistochemical staining, the pathologic tumor specimen was proved to be GH positive pituitary adenoma. This is the first case reported in the English literature of an acromegaly presenting with diabetic ketoacidosis and acute pancreatitis

A Case of Porphyria with Acute Pancreatitis.: Seok Won Chung, Jeong Hee Han, Young Min Ju, Kwang Hee Yoon, Won Seok Yang, Sung Koo Lee, Sung Kkwan Hong, Eun MEE hAN, Byung Sik Kim, Ki Up Lee; J Korean Endocr Soc. 2000;15(1):128-132. Published online January 1, 2001

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Abstract PDF: The porphyrias are a group of disorders caused by deficiency in the enzymes of the heme biosynthetic pathway. Patients with porphyria may develop neurovisceral attacks which include severe abdominal pain, neuropsychiatric manifestations and potentially fatal respiratory paralysis. However, these patients may also have abdominal pain not due to porphyria itself, and in such case, careful evaluation is important. We report a case of acute pancreatitis with masquerading acute attack of porphyria, which made us difficult to make a correct diagnosis. A 29-year-old female, previously diagnosed to have hepatic porphyria, presented with acute abdominal pain, back pain and leg pain for 3 days. Serum amylase was normal and 24-hour urine -ALA and PBG showed increased levels. After intravenous infusion of glucose, symptoms were improved. From the 10th day of admission, she complained severe abdominal pain, and was found to have severe metabolic acidosis, shock, and signs of peritonitis on the 12th day of admission. Emergency exploration revealed edematous pancreas. Amylase and lipase levels in serum and ascites were found to be markedly elevated. After conservative management, her general condition gradually improved and serum amylase and lipase levels were normalized.

Two Cases of Hyperparathyroidism Presenting as Acute Pancreatitis.: Sung Kil Lim, Young Jun Won, Young Duk Song, Hyun Chul Lee, Kap Bum Huh, Bai Jin Lee, Jun Myoung Kim, Yoo Bock Lee; J Korean Endocr Soc. 1997;12(2):321-327. Published online January 1, 2001

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Abstract PDF: The relationship between hypercalcemic crisis and pancreatitis, first described in patients with hyperparathyroidism, still remains controversial. Acute pancreatitis may complicate the clinical course of hyperparathyroidism, particularly when the degree of hypercalcemia is severe. The incidence of hyperparathyroidism presenting as acute pancreatitis appears to be steadily decreasing, possibly reflecting the earlier diagnosis of asymptomatic hyperparaparathyroidism due to widespread application of screening methods. Here, we report two patients with primary hyperparathyroidism manifesting clinically as acute pancreatitis. One patient died of progessive pancreatitis and uncontrolled sepsis. The other patient was fullly recovered by emergent parathyroidectomy followed by medical management of hypercalcemia.

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