Ayoub WA, Kumar AA, Naguib HS, Taylor HC
Exenatide Induced Acute Pancreatitis. [JOURNAL ARTICLE]
Endocr Pract 2009 Aug 24.:1-16.
OBJECTIVE: To report acute pancreatitis in a patient with type 2 diabetes mellitus (NIDDM) receiving exenatide and critically review previous reports.
METHODS: We detail clinical and laboratory data in a patient with likely exenatide induced pancreatitis and apply the same criteria to previous purported cases.
RESULTS: A 64 y.o. non alcoholic female with NIDDM presented with one month of epigastric pain beginning two days after starting exenatide. Serum lipase was 2700U/L (nl. 114-320) and amylase 131U/L (nl. 30-110). Liver tests, lipid profile and serum creatinine were normal. Abdominal computed tomography (CT) showed changes consistent with pancreatitis and absent gallbladder. Exenatide was discontinued. Conservative therapy resulted in rapid resolution of symptoms and normal lipase (151U/L) and CT of the pancreas 90 days later.The FDA has reported 36 cases of presumed pancreatitis associated with exenatide. However, none of the selection criteria were specified, 2/3 did not have CT and 90% had at least one other risk factor. The one published case report contained no description of the pancreas on abdominal CT, mention of alcohol use or normal values for lipase. We believe this current report to be the most thoroughly documented example of likely exenatide induced pancreatitis with a Naranjo score of 7/9. Reinstitution of all medications except exenatide and glipizide did not reproduce symptoms, CT or lipase abnormalities, and implicates exenatide as the cause.
CONCLUSION: In any diabetic patient with acute pancreatitis, exenatide use must be ruled out and if currently taken, discontinued.
More from this journal |
