Tamoxifen-Induced Severe Acute Pancreatitis: A Case Report

Acute pancreatitis is a condition that leads to destruc-tionand necrosis of pancreatic tissue and frequentdevelopment of multiple organ failure. Most cases arerelated to gallstones or heavy alcohol intake. Amongthe numerous other causes are hypertriglyceridemia,hypercalcemia, abdominal trauma, drugs, vasculitis, viralinfection, peritoneal dialysis, cardiopulmonary bypass,and endoscopic retrograde cholangiopancreatography.Approximately 2 to 5% of cases of acute pancreatitisare drug related, including such drugs as azathioprine,mercaptopurine, asparaginase, pentamidine, didanosine,valproic acid, tetracyclines, estrogen, sulfonamides,thiazides, furosemide, pentamidine, dideoxyinosine, andpossibly glucocorticoids.Tamoxifen is a nonsteroidal estrogen antagonist thathas been widely used in adjuvant hormonal therapy ofprimary breast cancer. The side effects of tamoxifenare generally mild, including effects on lipoproteinmetabolism (1-3). Tamoxifen lowers total and low-densitylipoprotein cholesterol and increases triglycerideand high-density lipoprotein cholesterol levels. However,there are some cases of marked, tamoxifen-induced,hypertriglyceridemia. Hypertriglyceridemia may occa-sionallyproduce severe, lethal pancreatitis (4-8). Here,we report a case of tamoxifen-induced severe, acutepancreatitis. The patient was a woman who had hyper-triglyceridemiaand breast cancer. After mastectomy, bothtamoxifen and antihyperlipidemic agents were adminis-tered.But she withdrew the lipid-lowering agent 2 yearslater on her own. Then she developed tamoxifen-inducedsevere hypertriglyceridemia and pancreatitis.