Tirzepatide in recurrent hypertriglyceridemia-mediated pancreatitis and type 2 diabetes: a case report

Background Hypertriglyceridemia‑mediated acute pancreatitis (HTG‑AP) is a clinically relevant complication of severe metabolic dysfunction, yet incretin‑based therapy is often withheld because current recommendations discourage its use in patients with a history of pancreatitis. Case presentation We report on a woman born in 1993 with severe hypertriglyceridemia known since 2018, type 2 diabetes diagnosed in 2022, recurrent HTG-AP from 2023 onward, chronic fibrosing pancreatitis, and severe metabolic dysfunction-associated steatotic liver disease (MASLD). Despite lifestyle measures, fenofibrate, high-dose omega-3 fatty acids, and intensified insulin therapy, she presented again in March 2025 with acute pancreatitis and triglycerides of 4.400 mg/dL. After stabilization of acute pancreatitis and marked triglyceride reduction due to prolonged fasting and intensified insulin therapy, tirzepatide was started on March 27, 2025. At initiation, triglycerides were 335 mg/dL and HbA1c was 7.0%. During follow-up, insulin was fully discontinued, triglycerides normalized to 137 mg/dL at 3 months and 85 mg/dL at 12 months, HbA1c improved to 5.5%, inflammatory markers normalized, and no further pancreatitis episodes occurred. Conclusion This single-patient case observation illustrates that tirzepatide may be considered on an individualized basis in selected cases of metabolically driven pancreatitis, particularly when metabolic dysfunction is presumed to be the dominant driver. However, the favorable clinical course observed in this case represents an association only and does not establish causality.