Korean J Intern Med.  2013 Sep;28(5):609-613. 10.3904/kjim.2013.28.5.609.

Gestational hyperlipidemia and acute pancreatitis with underlying partial lipoprotein lipase deficiency and apolipoprotein E3/E2 genotype

• Han DH
• Moh IH
• Kim DM
• Ihm SH
• Choi MG
• Yoo HJ
• Hong EG

• KMID: 1780111
• DOI: http://doi.org/10.3904/kjim.2013.28.5.609

Abstract

We report the case of a patient who experienced extreme recurrent gestational hyperlipidemia. She was diagnosed with partial lipoprotein lipase (LPL) deficiency but without an associated LPL gene mutation in the presence of the apolipoprotein E3/2 genotype. This is the first reported case of extreme gestational hyperlipidemia with a partial LPL deficiency in the absence of an LPL gene mutation and the apolipoprotein E 3/2 genotype. She was managed with strict dietary control and medicated with omega-3 acid ethyl esters. A patient with extreme hyperlipidemia that is limited to the gestational period should be considered partially LPL-deficient. Extreme instances of hyperlipidemia increase the risk of acute pancreatitis, and the effect of parturition on declining plasma lipid levels can be immediate and dramatic. Therefore, decisions regarding the timing and route of delivery with extreme gestational hyperlipidemia are critical and should be made carefully.

Keyword

Apolipoproteins E; Hyperlipidemias; Lipoprotein lipase; Pregnancy

MeSH Terms

Acute Disease
Adult
Apolipoprotein E2/*genetics
Apolipoprotein E3/*genetics
Biological Markers/blood
Combined Modality Therapy
Diet, Fat-Restricted
Fatty Acids, Omega-3/therapeutic use
Female
Fluid Therapy
Genetic Predisposition to Disease
Humans
Hyperlipoproteinemia Type I/blood/diagnosis/enzymology/*genetics/therapy
Lipids/blood
Lipoprotein Lipase/genetics
Pancreatitis/diagnosis/*etiology/therapy
Parenteral Nutrition, Total
Phenotype
Pregnancy
Pregnancy Complications/blood/diagnosis/enzymology/*genetics/therapy
Recurrence
Tomography, X-Ray Computed
Treatment Outcome
Apolipoprotein E2
Apolipoprotein E3
Biological Markers
Fatty Acids, Omega-3
Lipids
Lipoprotein Lipase