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2018 ; 12
(2
): 331-336
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Metabolic Pancreatitis: Pancreatic Steatosis, Hypertriglyceridemia, and
Associated Chronic Pancreatitis in 3 Patients with Metabolic Syndrome
#MMPMID30022925
Melitas C
; Meiselman M
Case Rep Gastroenterol
2018[May]; 12
(2
): 331-336
PMID30022925
show ga
Obesity, insulin resistance, and metabolic syndrome continue to increase in
prevalence. Hypertriglyceridemia is commonly associated and represents a valuable
marker of metabolic syndrome. An increase in subcutaneous fat deposition places
patients at risk for visceral adipose deposition in sites such as the liver,
heart, and pancreas. Pancreatic steatosis in the setting of metabolic syndrome is
a rapidly emerging entity whose clinical spectrum remains to be defined.
Hypertriglyceridemia is an accepted cause of acute pancreatitis but its role in
chronic pancreatic injury remains to be explored. We present 3 patients with
chronic abdominal pain and pancreatic steatosis in the setting of underlying
metabolic syndrome with hypertriglyceridemia. These cases were identified in one
endoscopic ultrasonographer's practice over a 12-month period. Each patient had
documented hypertriglyceridemia but no history of acute hypertriglyceride-induced
pancreatitis. A history of significant alcohol exposure was carefully excluded.
Each patient underwent endoscopic ultrasonography (EUS) which proved critical in
delineating the spectrum of chronic pancreatic injury. Each of our patients had
EUS documentation of pancreatic steatosis and sufficient criteria to establish a
diagnosis of chronic pancreatitis. Intraductal pancreatic calculi were identified
in all 3 patients. Our series suggests that in the setting of metabolic syndrome,
chronic hypertriglyceridemia and pancreatic steatosis may be associated with
chronic pancreatitis. We hypothesize that hypertriglyceridemia may provide a
pathogenic role in the development of chronic pancreatic microinjury. In
addition, each of our patients had EUS-documented pancreatic ductal lithiasis. To
our review, these are novel findings which have yet to be reported. We believe
that with an enhanced awareness, it is likely that the entity of metabolic
syndrome with features of pancreatic steatosis and hypertriglyceridemia with
their associated manifestations of chronic pancreatitis, including ductal
lithiasis, will be widely appreciated.