Severe hypertriglyceridemia and pancreatitis when estrogen replacement therapy is given to hypertriglyceridemic women
Glueck, C.J.; Lang, J.; Hamer, T.; Tracy, T.
Journal of Laboratory and Clinical Medicine 123(1): 59-64
1994
ISSN/ISBN: 0022-2143 PMID: 8288962 Document Number: 431291
Our specific aim was to assess severe hypertriglyceridemia and pancreatitis that occurred when postmenopausal estrogen replacement therapy (ERT) or tamoxifen had been given by their physicians to women with preexisting, usually covert, primary familial hypertriglyceridemia. We retrospectively studied 31 women referred for diagnosis and therapy of hypertriglyceridemia over 2.75 years whose initial visit fasting plasma triglyceride levels were gt 750 mg/dl. Of the 31 women with hypertriglyceridemia, 12 (39%) had been given exogenous estrogen by their physicians (11 ERT, one tomoxifen). Ton of the 12 women, while undergoing ERT, had triglyceride levels gt 1200 mg/dl. In triglyceride referral categories 750 to 1000, 1000-1500, and gt 1500 mg/dl, 17% (2 of 12), 33% (3 of 9), and 70% (7 of 10), respectively, of the 31 women with hypertriglyceridemic were receiving ERT. The higher the triglycerides were at referral, the greater was the likelihood that women were taking ERT (X-2 = 6.6, p = 0.035). Four of the seven women with triglyceride levels gt 1500 mg/dl while undergoing ERT were hospitalized with severe acute pancreatitis; another two had severe abdominal pain thought to be pancreatic in origin. To quickly lower dangerously high triglyceride levels, ERT was stopped in all 12 women. Lopid (1.2 to 1.5 gm/day) was given to the seven women not already taking it, and four were 0130 given omega-3 fatty acids (4 to 15 gm/day). Median plasma triglyceride level at the initial visit in the 12 women undergoing ERT was 1665 mg/dl. At their second visit, approximately 6 weeks later, when not undergoing ERT, and with all 12 women receiving diet plus Lopid (gemfibrozil), and with four also taking omega-3 fatty acids, triglyceride levels fell sharply to 293 mg/dl (p lt 0.0005). In women with pre-ERT triglyceride levels gt 300 mg/di, ERT is relatively contraindicated and should be absolutely contraindicated when triglyceride levels are gt 7.50 mg/dl, to avoid hypertriglyceridemic pancreatitis and exacerbation of preexisting, covert hypertriglyceridemia. Cessation of ERT and treatment with triglyceride-lowering regimens usually normalizes triglyceride levels in women with hypertriglyceridemia, but if ERT is continued, triglyceride-lowering therapy is usually ineffective.