Acute hyperlipidemic pancreatitis due to estradiol valerate/cyproterone acetate

Abstract

A 43-year-old woman received hormone replacement therapy because of menopause. She took 1 tablets of estradiol valerate/cyproterone acetate a day orally for 21 days continually and had an interval for 7 days, she repeated the cycle continuously. Her serum triglyceride (TG) was 1.55 mmol/L before the drug administration and increased to 3.25 mmol/L 18 months after the beginning of the treatment which was the result of a laboratory examination performed before blood donation. She took dietary control only. She developed abdominal pain, abdominal distention, nausea and vomiting after eating greasy food 24 months after the treatment started. She was hospitalized the next day. Laboratory examination revealed that TG was 23.00 mmol/L, amylase 892 U/L, lipase 560 U/L, urine amylase 1 020 U/L. Abdominal ultrasound examination showed diffuse enlargement of pancreas and obvious peripancreatic exudation. The patient was diagnosed as acute hyperlipidemic pancreatitis. Estradiol valerate/estradiol cyproterone was stopped. She received the symptomatic treatments, including fasting, gastrointestinal decompression, plasmapheresis, anti-inflammatory drugs, acid suppression, enzyme inhibition, and fluid resuscitation. The patient received plasmapheresis for 6 times totally. Her serum TG levels were 18.50, 15.00, 11.70, 9.20, 5.20 and 2.20 mmol/L, respectively. Twenty days later, all the symptoms of the patient disappeared completely and the patient was discharged. Key words: Estradiol valerate; Cyproterone; Hyperlipidemia; Pancreatitis