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Query: UMLS:C0020473 (hyperlipidemia)
 15,891 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Treating hyperlipidemia in diabetics requires distinguishing between hypercholesterolemia, with its high risk of cardiovascular disease, and hypertriglyceridemia, which, if severe, may cause pancreatitis. Hypercholesterolemia is best managed with diet and, if necessary, colestipol and niacin. Hypertriglyceridemia with chylomicrons responds best to diabetic control, weight loss, and low-fat diet.
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PMID:Hyperlipidemia - a diabetic emergency. 705 73

There are only 6 published reports of pancreatitis associated with oral contraception (OC). This article presents 1 additional case. A 28 year old white woman was hospitalized for severe abdominal pains; gastroenteritis was diagnosed and the patient treated with Compazine and Maalox. Because of the increasing severity of pains the patient was rehospitalized and pancreatitis secondary to hyperlipoproteinemia was diagnosed. OC treatment was suspended, and the patient was successfully treated with Cimetidine, antacids, and insulin for elevated glucose. Pancreatitis caused by OC is probably due to alterations in lipid metabolism, and related to the estrogen content of the preparation used. A major study done recently with 2 types of synthetic estrogens combined with 3 types of progestogens confirmed that hypertriglyceridemia induced by OC was estrogen dosage-related. It seems apparent that OC use in patients with intrinsic lipid abnormalities may be contraindicated; other risk patients are those who are obese, diabetic, or with family antecedents of diabetes or hyperlipidemia.
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PMID:Birth control pills and pancreatitis. 707 Jan 28

Type V hyperlipoproteinemia (HLP) is characterized clinically by hepatosplenomegaly, occasional eruptive xanthomas, and an increased incidence of pancreatitis. These patients have striking hypertriglyceridemia due to increased plasma chylomicron and very low density lipoprotein concentrations in the fasting state, without a deficiency of lipoprotein lipase or its activator protein, apolipoprotein (apo) C-II. ApoE, a protein constituent of triglyceride-rich lipoproteins, has been implicated in the receptor-mediated hepatic uptake of these particles. ApoE has three major alleles: E2, E3, and E4, and the products of these alleles are apoE2, apoE3, and apoE4, respectively. ApoE phenotypes were determined in 30 type V HLP patients as well as in 37 normal volunteers. Among the type V patients, 33.3% were noted to be homozygous, and 40.0% heterozygous for E4 (normal, 2.7 and 21.6%, respectively). These data suggest that apoE4 may play a role in the etiology of the hyperlipidemia in a significant number of type V HLP patients.
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PMID:Increased prevalence of apolipoprotein E4 in type V hyperlipoproteinemia. 709 73

Seventy-three cases of acute pancreatitis were studed in detail to determine the pattern and etiology in an alcohol free community. The majority of cases were found to be of the interstitial edematous type. For religious, cultural and legal reasons there were no true alcoholic cases. Over half (38) were of biliary origin. The remaining 35, at first described as "idiopathic" on admission, were carefully studied for the possible etiological factors. It was found that eight were attributable to steroids, 15 to estrogens and nine to tetracyclines and only three cases were described as "idiopathic". The criteria and reasons for their identification are reviewed. The author recommends careful study and monitoring of all cases termed idiopathic, as well as a high index of suspicion in patients receiving steroids, estrogens or tetracyclines, if they develop abdominal pain. It is advisable to avoid estrogens in cases of hyperlipidemia. The term iatrogenic pancreatitis should be applied to these cases.
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PMID:The etiological factors in 73 cases of acute pancreatitis. 727 7

Interrelationships between pregnancy, hypertriglyceridemia, and pancreatitis were assessed in three women with familial hypertriglyceridemia. One subject had known familial hypertriglyceridemia, familial type V hyperlipoproteinemia, prior to conception. In this woman a progressive increase in triglyceride levels to more than 3,000 mg/dl during the first two trimesters required dietary intervention and hospitalization at 28 weeks' gestation. Use of an isocaloric National Institutes of Health type V diet reduced triglyceride levels to less than 900 mg/dl; the pregnancy was uneventful with term delivery of a healthy neonate. The familial hypertriglyceridemia was covert in the other two women until term. In one subject, subsequently shown to have familial type V, acute hemorrhagic pancreatitis with a pancreatic pseudocyst, shock, and hypocalcemia developed at 39 weeks' gestation; the neonate was safely delivered, and the mother survived. In the second, entirely asymptomatic subject, triglyceride levels greater than 5,000 mg/dl were discovered incidentally at term cesarean section during delivery of a healthy neonate. With a fat restricted diet, plasma triglyceride levels abruptly fell post partum to less than 500 mg/dl, and subsequent studies revealed familial type III hyperlipoproteinemia. Routine quantitation of plasma cholesterol and triglyceride levels or simple visual examination of fasting plasma for triglyceride-induced opacity or "milky" appearance should be done during early pregnancy. This would allow the obstetrician to identify women with severe familial hypertriglyceridemia prior to the superimposition of the physiologic hyperlipidemia of pregnancy upon familial hypertriglyceridemia with resultant, and often catastrophic, acute pancreatitis.
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PMID:Pancreatitis, familial hypertriglyceridemia, and pregnancy. 735 61

A 47-year-old woman was evaluated for congenital dwarfism, primary amenorrhoea due to hypogonadotrophic hypogonadism, severe hyperlipidaemia with pancreatitis, and overt diabetes mellitus associated with severe insulin resistance requiring 2.5-3 units of insulin per kilogram body weight. Chromosomal analysis with trypsin banding was normal and biochemical evaluation revealed low oestrogen levels, inappropriately low gonadotrophins, very low IGF-I concentrations and GH concentrations unresponsive to insulin or L-dopa administration. Prolactin, pituitary-adrenal and pituitary-thyroid axes were normal. Dynamic testing with GnRH and GHRH produced increases in FSH, LH and GH concentrations. A MRI of the brain revealed no discernible hypothalamic abnormalities and a small pituitary. The presence of congenital combined growth hormone and gonadotrophin deficiency on the basis of a suprapituitary defect suggests the existence of common or related pathways regulating GnRH and GHRH synthesis or secretion and may have contributed to the ultimate development of insulin resistance and hyperlipidaemia.
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PMID:Isolated combined growth hormone and gonadotrophin deficiency due to hypothalamic dysfunction, associated with insulin resistance. 755 20

A rare case of pregnancy and successful transvaginal delivery in secondary diabetes due to chronic pancreatitis is reported. At the age of 16 the patient was diagnosed as having chronic pancreatitis probably caused by hyperlipemia. Three years later diabetes and calcification of the pancreas was found. Blood glucose was well controlled using both self-monitoring of blood glucose and multiple subcutaneous insulin injection just before she became pregnant at age 23. The dose of insulin was slightly increased and no acute exacerbation of pancreatitis occurred during pregnancy, partly due to an appropriate low fat diet with digestive enzyme preparations.
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PMID:Juvenile-onset pancreatic diabetes to whom a healthy infant was born. 760 97

During August 1989-August 1994 at the referral-based obstetric practice of MacKay Memorial Hospital in Taipei, Taiwan, obstetricians saw 8 pregnant women with acute pancreatitis. All but 1 patient had gallstones and/or hyperlipidemia. None had ever been diagnosed with pancreatitis or gallstones in the past. None suffered from alcoholism. One woman was lost to follow-up at 33 weeks gestation. No pregnant woman died. Magnesium sulfate and nifedipine controlled preterm labor in 2 patients. Two women underwent cesarean section (fetal distress and elective). Pancreatitis struck all but 1 during the 3rd trimester of pregnancy. One woman presented at 23 weeks gestation with loss of consciousness, abnormally low volume of circulating plasma in the body, upper gastrointestinal bleeding, and a dead fetus. She also had diabetes mellitus which had gone untreated for 2 years. After spontaneous delivery of the dead fetus, she developed metabolic encephalopathy, sepsis, respiratory distress, and acute renal failure. She completely recovered and left the hospital 62 days after arriving. Physicians instituted conservative treatment for pancreatitis and a fat-restricted diet for hyperlipidemia. Labor was induced in 3 women after determining fetal lung maturity. Pancreatitis symptoms diminished after delivery. At 2 weeks postpartum, they underwent cholecystectomy. In fact, all but 3 women underwent cholecystectomy. Five patients had a fever greater than 38 degrees Celsius upon admission. Three patients were jaundiced. All 8 patients experienced nausea and/or vomiting and abdominal pain. Six women had low serum calcium levels. Only 1 had a serum lactic dehydrogenase level above 350 IU/L. Primiparous women were just as likely to develop pancreatitis during pregnancy as multiparous women. These findings suggest that early diagnosis and prompt treatment of acute pancreatitis are essential to a favorable outcome.
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PMID:Acute pancreatitis in pregnancy. 766 Jul 65

Data of 26 patients suffering from severe pancreatitis, who were treated at the anesthesiologic intensive care unit during the years 1991 and 1992, were evaluated with respect to etiologic factors, especially hypertriglyceridemia, stage of the disease and clinical outcome. Hypertriglyceridemia was found in 13 cases (11 men, 2 women, mean age 42 +/- 9 years) with values between 330 mg/dl and 4000 mg/dl. Lipid electrophoresis revealed a pattern typical for type IV hyperlipidemia. Insulin dependent diabetes was present in 4 patients and 5 reported about an unusual high alcohol intake preceding pancreatitis. Beside surgical approaches, including drainage and lavage, and basic intensive care treatment plasmapheresis was performed in 8 patients with hypertriglyceridemia. 5 patients with pancreatitis and hypertriglyceridemia died out of multiorganic failure, and so the mortality rate was 38%. The group of patients with pancreatitis caused by cholelithiasis or chronic alcohol consumption showed a mortality rate of 46%. The poor outcome of pancreatitis associated with hypertriglyceridemia demonstrates the importance of the treatment of hypertriglyceridemia in order to prevent the development of pancreatitis. The determination of plasma triglyceride values should belong to the routine diagnostic procedures in acute pancreatitis.
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PMID:[Hypertriglyceridemia and acute pancreatitis]. 770 9

Recent apheresis therapy is developing day by day. Now we can say that we do not achieve suitable treatment without an apheresis technology. Acute and chronic renal failure, severe hepatic failure, acute necrotic pancreatitis and MOS are not able to treat without haemodialysis (HD), haemofiltration (HF) and plasma exchange (PE). Immunomodulation for immune complex diseases and removing of pathologic antibodies are controlled by this technique. In the near future, it will play an important role for controlling of xenotransplantation. LDL apheresis for hyperlipidemia is very effective in cleaning the blood, and the prevention of ASO, angina syndrome and coronary disease is discussed. LAK therapy and immune therapy using apheresis technique have been effective for cancer and it will be developed moreover. Lastly, apheresis used to prevent aging is the music of the future.
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PMID:[Today's apheresis therapy]. 774 69


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