Pancreatite aguda induzida por hipertrigliceridemia: aspectos clínicos e diagnósticos

Abstract

Introduction: Hypertriglyceridemia (HTG) is one of the most common causes of acute pancreatitis. It is reported to cause 1 to 30% of all cases of acute pancreatitis and up to 56% of cases during pregnancy. The risk of developing acute pancreatitis is approximately 5% with triglycerides >1000 mg/dL (11.2 mmol/L) and 10 to 20% with triglycerides >2000 mg/dL (22.6 mmol/L). The degree of triglyceride elevation is also associated with the severity of hypertriglyceridemia-induced pancreatitis (HTGP). Primary (genetic) and secondary disorders of lipoprotein metabolism are associated with HTGP. Triglycerides themselves do not appear to be toxic. Instead, it is the breakdown of triglycerides into toxic fatty acids by pancreatic lipases that is the cause of lipotoxicity during acute pancreatitis. Objectives: discuss the etiology, clinical aspects and diagnoses of acute pancreatitis induced by hypertriglyceridemia. Methodology: Literature review from Scielo, PubMed and VHL databases, from April to June 2024, with descriptors "acute pancreatitis", "hypertriglyceridemia" and "adults” Articles from 2019-2024 were included ( total 48), excluding other criteria and choosing 05 full articles. Results and discussions: The initial clinical presentation of HTGP is similar to that of acute pancreatitis due to other causes; abdominal pain, nausea and vomiting are the main complaints. Physical examination findings suggestive of underlying HTG include eruptive xanthomas over the extensor surfaces of the arms, legs, buttocks, and back, hepatosplenomegaly due to fatty infiltration, and retinal lipemia. It should be suspected in patients with acute pancreatitis and risk factors for HTG. Risk factors for HTG include poorly controlled diabetes, alcoholism, obesity, pregnancy, prior pancreatitis, and a personal or family history of HTG. Serum triglyceride levels >500 mg/dL (5.6 mmol/L) are required for HTG to be considered the underlying etiology of acute pancreatitis. Initial management of patients with HTGP includes treatment of acute pancreatitis, severe dietary fat restriction, and exclusion of culprit medication with the goal of reducing serum triglyceride levels to <500 mg/dL (5.6 mmol/L). Since triglyceride levels are <500 mg/dL (5.6 mmol/L), patients with HTGP require long-term therapy to prevent recurrent pancreatitis and prevent other complications of HTG. This consists of pharmacological therapy (e.g., oral gemfibrozil 600 mg twice daily) and dietary modification (e.g., fat- and simple sugar-restricted diet). Other non-pharmacological interventions include weight loss in obese patients, aerobic exercise, avoidance of concentrated sugars and medications that increase serum triglyceride levels, and tight glycemic control in patients with diabetes. Conclusion: Risk factors for HTG include poorly controlled diabetes, alcoholism, obesity, pregnancy, previous pancreatitis, and personal or family history of HTG. Serum triglyceride levels >500 mg/dL (5.6 mmol/L) are required for HTG to be considered the underlying etiology.