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Hypertriglyceridemia-Induced Acute Pancreatitis with Normal Pancreatic Enzymes

To the Editor: The diagnosis of acute pancreatitis requires 2 of the following 3 features: 1) abdominal pain consistent with acute pancreatitis; 2) serum lipase activity (or amylase activity) at least 3 times greater than the upper limit of normal; and 3) characteristic imaging findings of acute pancreatitis.1 Although normal serum amylase levels have been reported […]

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Emphysematous Pancreatitis

A 63-year-old woman with a history of severe alcohol abuse presented with persistent abdominal pain radiating to the back, vomiting, and lassitude over a week. Examination showed tachycardia, abdominal tenderness, and bipedal edema. Abdominal ultrasound demonstrated only fatty liver. Laboratory tests were notable for white blood cell count of 16.1 × 109/L, serum albumin 1.8 g/dL, and increased […]

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Slowly Growing Adrenal Mass: A 20-Year Incubation

A 68-year-old Japanese woman was referred for the evaluation of bilateral adrenal masses. These masses were incidentally discovered 20 years previously on computed tomography (CT) when they measured 2.5 cm and 2.0 cm (Figure 1A, B). At that time she had no signs or symptoms of adrenal cortical hormone excess or deficiency. The plasma corticotropin (ACTH) concentration was […]

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Diffuse Cerebral Edema from Acute Pancreatitis Induced by Hypertriglyceridemia

Hypertriglyceridemia is the third most common cause of acute pancreatitis, accounting for up to 4% of cases.1, 2Severe acute pancreatitis is characterized by persistent organ failure for >48 hours and warrants intensive care unit admission because it has a mortality rate of 20%.3 Patients with severe acute pancreatitis have been noted to have higher levels of proinflammatory […]

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