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

Although the negative predictive value of lipase is very high (≥95%) for the diagnosis of acute pancreatitis (6), cases presenting with normal serum amylase and lipase have been reported, especially in association with hypertriglyceridemia, extensive pancreatic necrosis (acute fulminant or acute chronic pancreatitis), gallstone pancreatitis, and alcohol-induced pancreatitis (5, 7). Plasma triglyceride levels >500 mg/dL interfere with the in vitro determination of the actual amylase level by preventing the calorimetric reading of the assay endpoint (5); however, the reasons for a normal serum lipase level in patients with hypertriglyceridemic pancreatitis are uncertain (7). After a PubMed and Scopus search, we recovered only three cases of hypertriglyceridemic pancreatitis secondary to somatotrophic pituitary adenoma with elevated lipase and amylase (8). This case could represent the ﬁrst case reported of hypertriglyceridemic pancreatitis with normal lipase secondary to a somatotrophic pituitary adenoma. 18 1. 2. 3. 4. 5. 6. 7. 8. Scacchi M, Cavagnini F. Acromegaly. Pituitary 2006;9(4):297–303. Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis: presentation and management. Curr Opin Lipidol 2009;20(6):497–504. Shah AM, Eddi R, Kothari ST, Maksoud C, DiGiacomo WS, Baddoura W. Acute pancreatitis with normal serum lipase: a case series. JOP 2010;11(4):369–372. Baldelli R, Battista C, Leonetti F, Ghiggi MR, Ribaudo MC, Paoloni A, D’Amico E, Ferretti E, Baratta R, Liuzzi A, Trischitta V, Tamburrano G. Glucose homeostasis in acromegaly: eﬀects of long-acting somatostatin analogues treatment. Clin Endocrinol (Oxf ) 2003;59(4):492–499. Murphy MJ, Sheng X, MacDonald TM, Wei L. Hypertriglyceridemia and acute pancreatitis. JAMA Intern Med 2013;173(2):162–164. Cartier T, Sogni P, Perruche F, Meyniard O, Claessens YE, Dhainaut JF, Der Sahakian G. Normal lipase serum level in acute pancreatitis: a case report. Emerg Med J 2006;23(9):701–702. Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101(10):2379–2400. Resheq YJ, Rinninger F, Lohse AW, Schramm C. An unusual cause of hypertriglyceridemic acute pancreatitis. Am J Gastroenterol 2012;107(6):957– 959. Baylor University Medical Center Proceedings Volume 27, Number 1

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