In patients with severe hypertriglyceridaemia and cholestasis, persistent hypercholesterolaemia despite triglyceride improvement may be driven by lipoprotein X.
May support lipoprotein X testing when cholesterol persists after triglyceride correction in cholestasis; hypothesis-generating for diagnostic strategies.
Hypertriglyceridaemia is an established cause of acute pancreatitis and responds to insulin therapy in addition to lipid lowering medication. We report a case of severe hypertriglycaeridemia of 149 mmol/L in a 36-year-old man with type 2 diabetes who presented to the surgical ward with abdominal pain due to pancreatitis and developed acute cholestasis, jaundice and eruptive xanthomata. His triglycerides improved to 3.8 mmol/L with sliding scale insulin within two weeks of in-hospital stay. However, his total cholesterol remained raised at 23.7 mmol/L. The lipoprotein electrophoresis confirmed the presence of lipoprotein X associated with bile obstruction, which contributed to an increase in total cholesterol. The total cholesterol normalized on improvement of his cholestasis.
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Stępień et al. (2013) studied this question.
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