Isotretinoin-Induced Hypertriglyceridemia: A Silent Trigger for Acute Pancreatitis in a Young Patient

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Journal of the Endocrine Society

Abstract

Introduction: Acute pancreatitis leads to about 200,000 hospital admissions annually in the U.S., with an increasing incidence. Isotretinoin, a potent retinoid used for severe acne and dermatologic conditions, is associated with several adverse effects, including hypertriglyceridemia. Although hypertriglyceridemia is a known side effect, the progression to acute pancreatitis is rare, affecting fewer than 1% of patients. This report presents a case of isotretinoin-induced hypertriglyceridemia resulting in acute pancreatitis in a patient with no other apparent risk factors. Clinical Case: A 31-year-old female with a history of severe acne and appendectomy presented to the emergency department with progressively worsening epigastric pain radiating to the right upper quadrant and back, associated with nausea and vomiting. She reported drinking a glass of wine occasionally but denied any history of lipid disorders, gallstones, abdominal trauma, or unusual bug bites. Her only medications were drospirenone-ethinyl estradiol and isotretinoin (40 mg twice daily), which she had been using for 8 months. Vital signs were within normal range. On physical examination, she had epigastric tenderness without rebound tenderness, guarding, or Costo vertebral angle tenderness. Laboratory results revealed triglycerides of 3323 mg/dL (n < 149) and a lipase level of 129 U/L (n < 60). The urine drug screen was negative, and the alcohol level was < 0.01. Beta-hydroxybutyrate 0.33mmol/L (n 0.02-0.27), B-HCG was negative, AST, ALT, alkaline phosphatase, bilirubin, creatinine, and BUN were all within reference range. Troponin was within normal range. EKG did not show sign of Ischemia. Abdominal ultrasound showed minimal free fluid along the liver and gallbladder, suggesting pancreatitis. CT imaging revealed peripancreatic fluid with fluid identified within the left anterior pararenal space, extending into the paracolic gutter, and free fluid in the pelvis suggesting interstitial pancreatitis. The patient was treated with Intravenous fluid, Bowel rest, pain medications and Insulin drip later transitioned to Fenofibrate. Her condition improved; Triglyceride was monitored closely which trended down. Isotretinoin was discontinued; she was discharged with fenofibrate. Follow up in an outpatient setting for workup of familial hypertriglyceridemia was arranged. Conclusion: Isotretinoin-induced hypertriglyceridemia leading to acute pancreatitis, though rare, should be considered when a patient on isotretinoin presents with symptoms of pancreatitis. Clinicians should be proactive in educating patients on the signs of pancreatitis and consider lipid screening, especially for those with risk factors for hypertriglyceridemia.

Volume

9

Issue

Suppl 1

First Page

A440

Last Page

A441

Comments

ENDO 2025 Endocrine Society Annual Meeting, July 12-15, 2025, San Francisco, CA

DOI

10.1210/jendso/bvaf149.824

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