SHM Converge Scientific Abstract ePoster Gallery-At the Crossroads of Gender-Affirming Care and Metabolic Disaster: Therapuetic Plasmapheresis Used to Treat Estrogen Induced Hypertriglyceridemic Acute Pancreatitis

At the Crossroads of Gender-Affirming Care and Metabolic Disaster: Therapuetic Plasmapheresis Used to Treat Estrogen Induced Hypertriglyceridemic Acute Pancreatitis

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This case report describes a 21-year-old transgender woman (assigned male at birth) on estradiol for gender-affirming therapy who developed recurrent acute pancreatitis complicated by diabetic ketoacidosis (DKA) and severe hypertriglyceridemia. She had type 1 and type 2 diabetes, obesity, psoriasis, and major depression, and had experienced four similar pancreatitis/DKA episodes in the prior six months. She presented with five days of worsening nausea, vomiting, and abdominal pain.<br /><br />On admission, labs and CT confirmed acute pancreatitis and DKA, with triglycerides of 5,680 mg/dL and marked metabolic derangements. Initial treatment included IV fluids, insulin infusion, pain control, antiemetics, and holding estrogen therapy. Fenofibrate was also started. Because of acute kidney injury and the severity of hypertriglyceridemia, nephrology recommended therapeutic plasmapheresis (TPE). After TPE, triglycerides fell rapidly to 656 mg/dL, with symptomatic improvement and improvement in several lab values. However, repeat imaging showed necrosis of the pancreatic head and neck with necrotic pseudocysts.<br /><br />The report highlights the mechanism by which estrogen can raise triglycerides, especially in patients with diabetes or other risk factors, leading to pancreatitis through increased blood viscosity and free fatty acid toxicity. It also notes that pancreatitis can trigger DKA.<br /><br />The authors conclude that estrogen therapy is a significant risk factor for life-threatening hypertriglyceridemia and recurrent pancreatitis, and that routine lipid monitoring is important in patients receiving gender-affirming estrogen. They also emphasize that TPE can produce rapid triglyceride reduction in hypertriglyceridemic pancreatitis, though its superiority over conventional insulin-based therapy remains uncertain.

Asset Subtitle

Arghyadeep Ganguly

Meta Tag

Author List Arghyadeep Ganguly, Neil Hughes

Category Clinical Vignettes

Concept Estrogen Therapy

Concept Hypertriglyceridemia

Concept Acute Pancreatitis

Concept Hypertriglyceridemia-Induced Acute Pancreatitis

Concept Diabetic Ketoacidosis

Distinguished Non-Finalist

Presenter Organization Western Michigan University, Homer Stryker M.D. School of Medicine

Presenting Author Arghyadeep Ganguly

Track Adult

Keywords

transgender woman

estradiol therapy

hypertriglyceridemia

acute pancreatitis

diabetic ketoacidosis

therapeutic plasmapheresis

gender-affirming therapy

pancreatic necrosis

fenofibrate

lipid monitoring

Estrogen Therapy

Hypertriglyceridemia

Acute Pancreatitis

Hypertriglyceridemia-Induced Acute Pancreatitis

Diabetic Ketoacidosis