Baystate Medical Center Springfield, MA, United States
Tiago Martins, MD1, Mojdeh Mostafavi, MD1, Syed Hamza Sohail, MD1, Rohit Singhania, MD, MS2 1Baystate Medical Center, Springfield, MA; 2University of Massachusetts Medical School - Baystate, Springfield, MA
Introduction: Acute pancreatitis is the result of inflammation within the pancreas that is diagnosed in patients who present with at least two of the following criteria: (1) acute epigastric abdominal pain; (2) significant elevation in pancreatic enzymes serum levels to at least three times the upper limit of normal; and (3) the presence of abnormal findings associated with acute pancreatitis on contrast-enhanced CT or MRI imaging. There are over 100 medications that are known to cause acute pancreatitis, accounting for 0.1%-2% of all acute pancreatitis cases. As of 2017, fewer than fifty known cases were documented for estrogen-induced pancreatitis. Although there have been several documented cases of estrogen-induced acute pancreatitis due to HRT and oral contraceptives, this is to the best of our knowledge the first reported case in the U.S. of estrogen-induced acute pancreatitis in a patient undergoing IVF.
Case Description/Methods: The patient was a 34-year-old female with no pertinent past medical history other than two prior miscarriages (G3P1) prompting IVF treatment with estrogen therapy for approximately three years. The patient presented at 6-weeks gestation with complaints of nausea, vomiting, and significant abdominal pain over a period of several weeks. She denied any alcohol, tobacco or recreational drug use. Labs at that time revealed elevated lipase of 345 IU/L, AST of 61 IU/L, ALT of 123 IU/L, with normal bilirubin of 0.6 mg/dL. She had a normal triglyceride level. She underwent magnetic resonance cholangiopancreatography (MRCP), which revealed multiple enlarged pancreatic cystic lesions, a complex cystic mass-like lesion at the pancreatic head, gallbladder sludge, and intrahepatic and extrahepatic ductal dilatation (Image 1); however, no stones were visualized. She ultimately underwent endoscopic retrograde cholangiopancreatography (ERCP) with successful drainage of a large retrogastric pancreatic pseudocyst.
Discussion: Acute pancreatitis remains one of the leading concerns for inpatient gastroenterological care, with complications including pseudocyst formation, pancreatic necrosis and hemorrhage. The association between acute pancreatitis and estrogen therapy has been described previously in the literature. In this report, we describe a case of acute pancreatitis in which estrogen used as part of IVF treatment was felt to be the trigger. In conclusion, the risks of acute pancreatitis should be considered when prescribing estrogen to women with other risk factors for pancreatitis.
Figure: Image 1: Large peripancreatic/pancreatic fluid collection with confluence of collections extending from the uncinated process to the pancreatic tail measuring 18 x 8 x 16 cm. This is prior to stent placement.
Image 2: Imaging post ERCP showed almost complete disappearance of the large previously noted thinly walled fluid collection.
Tiago Martins indicated no relevant financial relationships.
Mojdeh Mostafavi indicated no relevant financial relationships.
Syed Hamza Sohail indicated no relevant financial relationships.
Rohit Singhania indicated no relevant financial relationships.
Tiago Martins, MD1, Mojdeh Mostafavi, MD1, Syed Hamza Sohail, MD1, Rohit Singhania, MD, MS2. P0067 - Interstitial Pancreatitis With Pseudocysts: A Diagnostic Mystery, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.