Baylor University Medical Center Proceedings January 2014, Volume 27, Number 1 | Page 18

Newly diagnosed acromegaly presenting with
hypertriglyceridemic pancreatitis with normal amylase
and lipase levels
David Sotello, MD, Ana Marcella Rivas, MD, and Kenneth M. Nugent, MD

The incidence of hypertriglyceridemia in acromegaly is three times higher
than in the normal population, and it is the most common dyslipidemia in
acromegaly. We present a case of hypertriglyceridemic pancreatitis confirmed by imaging, with normal pancreatic enzymes. Hypertriglyceridemia
in this patient was likely secondary to acromegaly. The hypertriglyceridemic pancreatitis appears to be secondary to somatotrophic pituitary
adenoma.

Table 1. Admission serum laboratory values
Variable

Value

White blood cell count (× 103/mm3 )

13.7

Hemoglobin (g/dL)

13.6

Platelets (×

103/mm3)

307

A

128

Sodium corrected for triglycerides (mEq/L)

cromegaly occurs as a result of excessive production of
growth hormone (GH), with more than 98% of cases
being caused by a pituitary adenoma (1). Moderate
hypertriglyceridemia is a complication of acromegaly.
Among the causes of acute pancreatitis, severe hypertriglyceridemia accounts for about 10% of the cases (2). The serum
lipase and amylase levels are usually elevated. Normal serum
lipase in the setting of acute pancreatitis is an extremely rare
occurrence (3). We present a case of acute hypertriglyceridemic
pancreatitis with normal serum amylase and lipase levels associated with acromegaly.

Sodium (mEq/L)

129

Potassium (mEq/L)

3.5

Glucose (mg/dL)

201

Creatinine (mg/dL)

0.3

Blood urea nitrogen (mg/dL)

7

16

10.5

Albumin (g/dL)

3.6

Total bilirubin (g/dL)

0.3

Alkaline phosphatase (IU/L)

114

Aspartate aminotransferase (IU/L)

11

Alanine aminotransferase (IU/L)

9

Amylase (IU/L)

CASE REPORT
A 30-year-old Hispanic man with recently diagnosed
diabetes mellitus presented to the emergency department
with 4 days of intermittent colicky left upper quadrant pain,
8/10 in intensity, nonradiating, and associated with anorexia.
He denied nausea, vomiting, diarrhea, and fever. His blood
pressure was 130/70 mm Hg; temperature, 99.3ºF; heart
rate, 99 beats per minute; and respirations, 16 per minute.
He was 70" tall and weighed 76 kg, for a body mass index
of 24.2 kg/m2. His voice was deep, and he demonstrated
prognathism, teeth separation, thickened skin, and broad
hands and feet. His left upper quadrant was tender without
rebound, there was no visceromegaly, and bowel sounds were
normal. Laboratory results are shown in Table 1. Computed
tomography (CT) of the abdomen showed a thickened pancreas with subtle haziness and stranding in the surrounding
peripancreatic fat and a small amount of fluid in the anterior
pararenal space (Figure 1a). After treatment with intravenous
fluid therapy, subcutaneous insulin, analgesia, and fenofibrate, his symptoms gradually improved.

Calcium (mg/dL)

33

Lipase (IU/L)

31

Hemoglobin A1C (%)

14

Osmolality (mOsm/kg)

294

Total cholesterol (mg/dL)

683

Triglycerides (mg/dL)

636

Thyroid-stimulating hormone (μIU/mL)

0.16

Free thyroxine (T4) (ng/dL)

1.10

Free triiodothyronine (T3) (pg/mL)

1.59

Insulin-like growth factor-1 (ng/mL)

640

Growth hormone (ng/mL)

34.3

From the Department of Internal Medicine, Texas Tech University Health Sciences
Cent \