ORAL CONTRACEPTIVE-INDUCED PANCREATITIS IN THE HYPERCHYLOMICRONEMIA SYNDROME

A now 24-year-old woman was found at the age of 2 years to have an hyperchylomicronaemia Syndrome due to lipoprotein lipase deficiency: the triglyceride level was then 6000 mg/dl. But in subsequent years it had been reduced to between 550 and 2600 mg/dl by dieting. There were no xanthomas or abdominal symptoms during those years. When aged 20 years she was put on oral contraceptives (one-phase preparation: 0.03 mg ethinylestradiol and 0.075 gestodene). Six months later she had the first attack of severe necrotizing pancreatitis; three more attacks followed in the subsequent 6 months. All four attacks occurred during the drug- free period of the menstrual cycle. The relationship with contraceptive intake was not established until the fourth attack. The last acute pancreatitis (lipase 3283U/l, amylase 595U/l, triglyceride 2400 mg/dl, WBC count 13 899/mu l; ultrasonography revealed fluid swelling and necrotic areas, especially around the splenic hilus) regressed within 5 days and has not recurred for 3 years after the patient stopped taking oral contraceptives. On a diet the triclyceride level has been around 880 mg/dl.