Need for Screening Triglyceride Levels in Women on Oral Contraceptives

Introduction: Oral contraceptive pills (OCPs) are the most used form of reversible contraceptives by women. Major risks are cardiovascular but OCPs also cause secondary hypertriglyceridemia (HTG) through effects of estrogen, which decreases hepatic triglyceride lipase and lipoprotein lipase activity...

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Autores principales: Yau, Alice, Idowu, Abidemi, Elayaperumal, Pramma, Gryguc-Saxanoff, Agnieszka, Martinez, Jose, Bahtiyar, Gul, Rodriguez, Giovanna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089513/
http://dx.doi.org/10.1210/jendso/bvab048.1591
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author Yau, Alice
Idowu, Abidemi
Elayaperumal, Pramma
Gryguc-Saxanoff, Agnieszka
Martinez, Jose
Bahtiyar, Gul
Rodriguez, Giovanna
author_facet Yau, Alice
Idowu, Abidemi
Elayaperumal, Pramma
Gryguc-Saxanoff, Agnieszka
Martinez, Jose
Bahtiyar, Gul
Rodriguez, Giovanna
author_sort Yau, Alice
collection PubMed
description Introduction: Oral contraceptive pills (OCPs) are the most used form of reversible contraceptives by women. Major risks are cardiovascular but OCPs also cause secondary hypertriglyceridemia (HTG) through effects of estrogen, which decreases hepatic triglyceride lipase and lipoprotein lipase activity. This causes increased triglycerides, cholesterol and free fatty acids,(1) which then in turn can lead to life-threatening acute pancreatitis. Case Description: A 23-year-old morbidly obese (BMI 38.2 mg/kg(2)) female presented with severe epigastric pain, nausea and vomiting. She had a history of mild intermittent asthma, recently diagnosed pre-diabetes and recently started on OCPs. Initial labs were consistent with diabetic ketoacidosis with glucose 528 mg/dL (65-115 mg/dL), anion gap 21 mEq/L (5-15 mEq), and beta-hydroxybutyrate 2.00 mmol/L (0.02-0.27 mmol/L); and acute pancreatitis with triglyceride 4,425 mg/dL (30-200 mg/dL) and lipase >600 U/L (8-78 UL), confirmed on imaging. She rapidly deteriorated, developing acute hypoxemic respiratory distress requiring intubation and distributive shock requiring three vasopressors. She progressed into multi-organ failure with acute respiratory distress syndrome, ischemic liver and acute renal failure despite insulin drip, colloidal fluid resuscitation, continuous veno-venous hemofiltration and high positive end-exploratory pressures. She developed rhabdomyolysis, followed by abdominal compartment syndrome requiring decompressive laparotomy that resulted in large volume blood loss and retroperitoneal necrosis needing multiple laparotomies. Ultimately, she became non-responsive off sedation, attributed to malignant cerebral edema that progressed to brain herniation. While HTG was likely the cause of her pancreatitis, she had normal triglyceride levels on prior routine lab work while not on OCPs. Discussion: Severe acute pancreatitis is a life-threatening complication of HTG which may be precipitated by use of OCPs. We believe that there is a need for more research in this field and even propose periodic monitoring of HTG in women taking OCPs given the severity of the consequences. While there are currently no guidelines for monitoring lipid levels in women on OCP, appropriate clinical awareness of physicians prescribing OCPs to patients may prevent fatal outcomes. References: 1. Stumpf, M., Kluthcovsky, A., Okamoto, J., Schrut, G., Cajoeiro, P., Chacra, A. and Bizeli, R. (2018). Acute pancreatitis secondary to oral contraceptive-induced hypertriglyceridemia: a case report. Gynecological Endocrinology, 34(11), pp.930-932.
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spelling pubmed-80895132021-05-06 Need for Screening Triglyceride Levels in Women on Oral Contraceptives Yau, Alice Idowu, Abidemi Elayaperumal, Pramma Gryguc-Saxanoff, Agnieszka Martinez, Jose Bahtiyar, Gul Rodriguez, Giovanna J Endocr Soc Reproductive Endocrinology Introduction: Oral contraceptive pills (OCPs) are the most used form of reversible contraceptives by women. Major risks are cardiovascular but OCPs also cause secondary hypertriglyceridemia (HTG) through effects of estrogen, which decreases hepatic triglyceride lipase and lipoprotein lipase activity. This causes increased triglycerides, cholesterol and free fatty acids,(1) which then in turn can lead to life-threatening acute pancreatitis. Case Description: A 23-year-old morbidly obese (BMI 38.2 mg/kg(2)) female presented with severe epigastric pain, nausea and vomiting. She had a history of mild intermittent asthma, recently diagnosed pre-diabetes and recently started on OCPs. Initial labs were consistent with diabetic ketoacidosis with glucose 528 mg/dL (65-115 mg/dL), anion gap 21 mEq/L (5-15 mEq), and beta-hydroxybutyrate 2.00 mmol/L (0.02-0.27 mmol/L); and acute pancreatitis with triglyceride 4,425 mg/dL (30-200 mg/dL) and lipase >600 U/L (8-78 UL), confirmed on imaging. She rapidly deteriorated, developing acute hypoxemic respiratory distress requiring intubation and distributive shock requiring three vasopressors. She progressed into multi-organ failure with acute respiratory distress syndrome, ischemic liver and acute renal failure despite insulin drip, colloidal fluid resuscitation, continuous veno-venous hemofiltration and high positive end-exploratory pressures. She developed rhabdomyolysis, followed by abdominal compartment syndrome requiring decompressive laparotomy that resulted in large volume blood loss and retroperitoneal necrosis needing multiple laparotomies. Ultimately, she became non-responsive off sedation, attributed to malignant cerebral edema that progressed to brain herniation. While HTG was likely the cause of her pancreatitis, she had normal triglyceride levels on prior routine lab work while not on OCPs. Discussion: Severe acute pancreatitis is a life-threatening complication of HTG which may be precipitated by use of OCPs. We believe that there is a need for more research in this field and even propose periodic monitoring of HTG in women taking OCPs given the severity of the consequences. While there are currently no guidelines for monitoring lipid levels in women on OCP, appropriate clinical awareness of physicians prescribing OCPs to patients may prevent fatal outcomes. References: 1. Stumpf, M., Kluthcovsky, A., Okamoto, J., Schrut, G., Cajoeiro, P., Chacra, A. and Bizeli, R. (2018). Acute pancreatitis secondary to oral contraceptive-induced hypertriglyceridemia: a case report. Gynecological Endocrinology, 34(11), pp.930-932. Oxford University Press 2021-05-03 /pmc/articles/PMC8089513/ http://dx.doi.org/10.1210/jendso/bvab048.1591 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Reproductive Endocrinology
Yau, Alice
Idowu, Abidemi
Elayaperumal, Pramma
Gryguc-Saxanoff, Agnieszka
Martinez, Jose
Bahtiyar, Gul
Rodriguez, Giovanna
Need for Screening Triglyceride Levels in Women on Oral Contraceptives
title Need for Screening Triglyceride Levels in Women on Oral Contraceptives
title_full Need for Screening Triglyceride Levels in Women on Oral Contraceptives
title_fullStr Need for Screening Triglyceride Levels in Women on Oral Contraceptives
title_full_unstemmed Need for Screening Triglyceride Levels in Women on Oral Contraceptives
title_short Need for Screening Triglyceride Levels in Women on Oral Contraceptives
title_sort need for screening triglyceride levels in women on oral contraceptives
topic Reproductive Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089513/
http://dx.doi.org/10.1210/jendso/bvab048.1591
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