ODP156 A Case Report of Clomiphene induced Severe Hypertriglyceridemia

BACKGROUND: The effects of estrogen on lipids have been well studied whereby estrogen has been shown to decrease total cholesterol and low-density lipoprotein (LDL) cholesterol concentrations and increase high-density lipoprotein (HDL) cholesterol and triglyceride (TG) levels. On the other hand, the effects of clomiphene, a selective estrogen receptor modulator have not been well established. CLINICAL CASE: A 34-year-old woman with a significant history of type II diabetes who recently started taking self-prescribed clomiphene presented with epigastric pain, nausea, and vomiting. Abdominal examination revealed generalized abdominal tenderness. Laboratory testing revealed normal lipase (30 U/L, normal range 6-51 U/L), increased serum glucose (268 mg/dL, normal range 60-140 mg/dL), and significant elevated TG level (6576 mg/dL, normal range 0-149 mg/dL). Her TG level was 345 mg/dl five months prior to presentation. Abdominal ultrasonography was revealed with no evidence of gallstones and a heterogenous pancreas. She was treated with an insulin infusion and aggressive fluid resuscitation, and her TG level improved to 255 mg/dL after treatment. Given her recent clomiphene use, the patient was deemed to have developed clomiphene-induced severe hypertriglyceridemia. The patient was advised to stop further clomiphene indefinitely and was discharged with fenofibrate 145mg daily and fish oil i. e. omega-3 fatty acid 4g daily for her hypertriglyceridemia. She was asked to follow up with endocrinology outpatient after discharge; however, she was unfortunately lost to follow-up. CONCLUSION: This is a rare case report of hypertriglyceridemia caused by using clomiphene citrate. Serum lipid levels should be measured and followed up closely for patients having risk factors predisposing to hyperlipidemia while using clomiphene citrate. Reference: Castro, M. R., T. T. Nguyen, and T. O'Brien, Clomiphene-induced severe hypertriglyceridemia and pancreatitis. Mayo Clin Proc, 1999. 74(11): p. 1125-8. Presentation: No date and time listed