Subcutaneous NPH Insulin for Severe Hypertriglyceridemia in a Pregnant Patient with Type V Hyperlipoproteinemia: a Case Report

Abstract

An increase in triglyceride levels in familial hyperlipidemia during pregnancy has been reported. Severe hypertriglyceridemia can lead to complications such as acute pancreatitis, preeclampsia, maternal and fetal complications. Because of the teratogenic effects associated with fibrate therapy in pregnancy, alternative treatment strategies such as insulin as a rapid and potent activator of lipoprotein lipase are required during pregnancy. We report a case of hypertriglyceridemia in a 33-year-old pregnant woman in whom treatment with merely single one time administration of Neutral Protamine Hagedorn insulin was accompanied by a reduction in the serum triglyceride level; to the best of our knowledge, this has never been reported in the literature. Her triglyceride level was 3616 mg/dL before insulin treatment and 1246 mg/dL after insulin treatment. Although this regimen was used safely and effectively in our patient, comprehensive studies are required to evaluate the effectiveness and safety of subcutaneously intermediate-acting Neutral Protamine Hagedorn insulin for the treatment of severe hypertriglyceridemia in non-diabetic pregnant women. Turkish Başlık: Tip V Hiperlipoproteinemili Gebe Bir Hastada Şiddetli Hipertrigliseridemi İçin Verilen Subkutan NPH Insulin Tedavisi: Vaka Sunumu Anahtar Kelimeler: Hamilelik, hipertrigliseridemi, insülin Gebelerde ve familyal hiperlipidemilerde gebelik sırasında trigliserit düzeylerinde artış olmaktadır. Şiddetli hipertrigliseridemi akut pankreatit, preeklampsi, anne ve bebekte komplikasyonlara yol açabilir. Gebelik döneminde fibrat tedavisinin teratojenik etkilerinden dolayı, lipoprotein lipazın hızlı ve güçlü bir aktivatörü olan insulin gibi alternatif tedavi yöntemleri gerekebilir. Biz, serum trigliserid düzeylerini azaltmak amacı ile sadece tek doz Nötral Protamin Hadegorn insulin ile tedavi ettiğimiz, literatürde daha önceden rapor edilmemiş 33 yaşında hipertrigliseridemisi olan gebe bir hastayı bildirdik. Hastanın insulin tedavi öncesi trigliserid düzeyi 3616 mg/dl iken tedavi sonrası 1246 mg/dl oldu. Bu tedavi rejimi hastamızda etkili ve güvenli olmasına karşın, diyabetik olmayan şiddetli hipertrigliseridemik gebelerde subkutan yolla verilen orta etkili Nötral Protamin Hadegorn insülinin etkinliğini ve güvenilirliğini değerlendirecek kapsamlı çalışmalara gerek vardır

Keywords

• Pregnancy, hypertriglyceridemia, insulin

Subcutaneous NPH Insulin for Severe Hypertriglyceridemia in a Pregnant Patient with Type V Hyperlipoproteinemia: a Case Report

Öz

References

1. Ma Y, Ooi TC, Liu MS, Zhang H, McPherson R, Edwards AL, et al. High frequency of mutations in the human lipoprotein lipase gene in pregnancy-induced chylomicronemia: possible associa- tion with apolipoprotein E2 isoform. Journal of lipid research 1994;35:1066-75.
2. McGladdery SH, Frohlich JJ. Lipoprotein lipase and apoE poly- morphisms: relationship to hypertriglyceridemia during pregnan- cy. Journal of lipid research 2001;42:1905-12.
3. Fahraeus L, Larsson-Cohn U, Wallentin L. Plasma lipoproteins including high density lipoprotein subfractions during normal pregnancy. Obstetrics and gynecology 1985;66:468-72.
4. Herrera E, Lasuncion MA, Gomez-Coronado D, Aranda P, Lopez- Luna P, Maier I. Role of lipoprotein lipase activity on lipoprotein metabolism and the fate of circulating triglycerides in pregnancy. American journal of obstetrics and gynecology 1988;158:1575-83.
5. Hsia SH, Connelly PW, Hegele RA. Successful outcome in se- vere pregnancy-associated hyperlipemia: a case report and lit- erature review. The American journal of the medical sciences 1995;309:213-8. [CrossRef]
6. Eckel RH. Lipoprotein lipase. A multifunctional enzyme relevant to common metabolic diseases. The New England journal of medicine 1989;320:1060-8.
7. Standards of medical care in diabetes--2011. Diabetes care 2011;34:S11-61. [CrossRef]
8. Beaumont JL, Carlson LA, Cooper GR, Fejfar Z, Fredrickson DS, Strasser T. Classification of hyperlipidaemias and hyper- lipoproteinaemias. Bulletin of the World Health Organization 1970;43:891-915.

9. Saravanan P, Blumenthal S, Anderson C, Stein R, Berkelhammer C. Plasma exchange for dramatic gestational hyperlipidemic pancreatitis. Journal of clinical gastroenterology 1996;22:295-8. [CrossRef]
10. Al-Shali K, Wang J, Fellows F, Huff MW, Wolfe BM, Hegele RA. Successful pregnancy outcome in a patient with severe chylomi- cronemia due to compound heterozygosity for mutant lipopro- tein lipase. Clinical biochemistry 2002;35:125-30. [CrossRef]
11. Ujhazy E, Onderova E, Horakova M, Bencova E, Durisova M, Nosal R, et al. Teratological study of the hypolipidaemic drugs etofylline clofibrate (VULM) and fenofibrate in Swiss mice. Phar- macology & toxicology 1989;64:286-90. [CrossRef]
12. Jabbar MA, Zuhri-Yafi MI, Larrea J. Insulin therapy for a non-di- abetic patient with severe hypertriglyceridemia. Journal of the American College of Nutrition 1998;17:458-61. Balkan Med J 2012; 29: 222-4
13. NPH Insulin Treatment for Severe Hypertriglyceridemia in a Pregnant Patient