Hypertriglyceridemic Pancreatitis Caused by the Oral Contraceptive Agent Estrostep.

Area of Science:

• Endocrinology
• Gastroenterology
• Pharmacology

Background:

• Norethindrone acetate/ethinyl estradiol is an "estrophasic" oral contraceptive with continuous low progestin and increasing estrogen doses.
• Clinical trials indicated no significant serum lipid level changes with this medication.
• This oral contraceptive is commonly prescribed for birth control.

Observation:

• A 24-year-old woman developed severe hypertriglyceridemia-induced acute pancreatitis.
• The condition arose nearly 10 years after initiating norethindrone acetate/ethinyl estradiol.
• She presented with severe hypertriglyceridemia (2,200 mg/dL), hyponatremia, and hypocalcemia.

Findings:

• The patient required intensive care unit admission for management of electrolyte abnormalities and pancreatitis.
• Treatment involved insulin infusion, omega-3 fatty acid esters, and gemfibrozil.
• Insulin infusion significantly reduced triglyceride levels within 7 days.

Implications:

• This is the first reported case of acute pancreatitis caused by hypertriglyceridemia linked to this specific oral contraceptive.
• Highlights the potential for rare but severe adverse effects with long-term oral contraceptive use.
• Suggests the need for monitoring lipid profiles in patients on oral contraceptives, particularly with prolonged use or other risk factors.