Estrogen-Induced Severe Hypertriglyceridemia Presenting as Recurrent Acute Pancreatitis Successfully Managed with Intravenous Insulin Infusion

Abstract

Introduction: Hypertriglyceridemia is an underrecognized cause of acute pancreatitis, especially in reproductive-age females without obvious risk factors. Careful history taking is essential, particularly drug history. Estrogen use, often for menstrual irregularities, may be over looked but can significantly elevate triglyceride levels and precipitate pancreatitis, warranting targeted clinical inquiry.

Case Presentation: We report a 26-year-old female admitted to the Medical ICU with severe abdominal pain who was diagnosed with acute pancreatitis. Laboratory evaluation revealed markedly elevated triglyceride levels of 4694 mg/dL. She had a history of menstrual irregularities, hirsutism, and recent use of oral estradiol for menstrual period regulation, secondary to suspected underlying polyendocrine metabolic ovarian syndrome. The patient was managed in the intensive care unit with continuous intravenous insulin infusion, resulting in a rapid decline in triglyceride levels to 640 mg/dL within 24 hours, along with significant clinical improvement. She was simultaneously started on fibrates and high doses omega-3 fatty acids.

Conclusion: Estrogen triggered hypertriglyceridemia with metabolic predisposition can cause pancreatitis; intravenous insulin offers rapid, effective, and accessible treatment in resource-limited settings.