Subclinical chronic pancreatitis in type I hyperlipoproteinemia

Area of Science:

• Gastroenterology
• Endocrinology
• Metabolic Disorders

Background:

• Familial type I hyperlipoproteinemia (fat-induced hyperlipemia) is characterized by elevated plasma triglyceride levels.
• Pancreatic exocrine insufficiency (PEI) impairs the digestion and absorption of nutrients, particularly fats.

Observation:

• A 41-year-old male with familial type I hyperlipoproteinemia presented with severe PEI, evidenced by increased fecal fat excretion and a blunted triglyceride response to dietary fat.
• Intestinal function tests were normal, but secretin stimulation revealed diminished duodenal fluid volume, bicarbonate, and pancreatic enzyme output.

Findings:

• Pancreatic enzyme replacement therapy reduced fecal fat excretion and increased plasma triglyceride levels, indicating improved fat absorption and metabolic control.
• The patient had a history of insulin-dependent diabetes mellitus diagnosed three years prior, with no reported acute pancreatitis in two decades.

Implications:

• This case suggests PEI can be a late complication of hyperlipemic disorders, even without a history of recurrent acute pancreatitis.
• Subclinical pancreatic damage from chronic hyperlipidemia may underlie PEI, with steatorrhea potentially masked by dietary fat restriction.