Clomiphene-Induced Severe Hypertriglyceridemia and Acute Pancreatitis: A Case Report and Literature Review.

Clomiphene citrate, a selective estrogen receptor modulator widely used for ovulation induction, has been rarely associated with severe hypertriglyceridemia, representing an under-recognized but potentially serious adverse effect. We present a case of clomiphene-induced severe hypertriglyceridemia complicated by acute pancreatitis in a 34-year-old woman with type 2 diabetes and baseline moderate hypertriglyceridemia who presented with acute epigastric pain after two months of unprescribed use of clomiphene for fertility purposes. Laboratory investigations revealed severe hypertriglyceridemia of 6,576 mg/dL (normal <150 mg/dL), representing a 19-fold increase from her baseline level of 345 mg/dL five months prior, along with hyperglycemia (268 mg/dL), elevated HbA1c (10.2%), and imaging consistent with acute pancreatitis secondary to hypertriglyceridemia. The patient was treated with aggressive fluid resuscitation and continuous insulin infusion, resulting in a reduction in triglycerides to 255 mg/dL within three days, and clomiphene was permanently discontinued. She was discharged on a regimen of fenofibrate 145 mg daily and a total of 4 g of omega-3 fatty acids daily, and her triglyceride levels normalized to 288 mg/dL at discharge. This case highlights the importance of baseline lipid screening and monitoring in patients receiving clomiphene therapy, particularly those with pre-existing metabolic risk factors, and clinicians should maintain high clinical suspicion for drug-induced hypertriglyceridemia in patients presenting with acute pancreatitis while on clomiphene therapy, as immediate discontinuation and initiation of appropriate lipid-lowering treatment can lead to rapid improvement in triglyceride levels.