Steroid-Induced Pancreatitis: A Challenging Diagnosis

The causality between use of glucocorticoids and risk of pancreatitis: a Mendelian randomization study

Background and aim

To date, the association between glucocorticoid use and the risk of pancreatitis remains controversial. The aim of this study was the investigation of this possible relationship.

Methods

We carried out a two-sample Mendelian randomization (MR) analysis using GWAS data from European ancestry, East Asian descendants and the FinnGen Biobank Consortium to evaluate this potential causal relationship. Genetic variants associated with glucocorticoid use were selected based on genome-wide significance (p < 5×10-8).

Results

Our MR analysis of European ancestry data revealed no significant causal relationship between glucocorticoid use and AP (IVW: OR=1.084, 95% CI= 0.945-1.242, P=0.249; MR-Egger: OR=1.049, 95% CI= 0.686-1.603, P=0.828; weighted median: OR=1.026, 95% CI= 0.863-1.219, P=0.775) or CP (IVW: OR=1.027, 95% CI= 0.850-1.240, P=0.785; MR-Egger: OR= 1.625, 95% CI= 0.913-2.890, P= 0.111; weighted median: OR= 1.176, 95% CI= 0.909-1.523, P= 0.218). Sensitivity analyses, including MR-Egger and MR-PRESSO, indicated no evidence of pleiotropy or heterogeneity, confirming the robustness of our findings. Multivariable MR analysis adjusted for alcohol consumption, BMI, cholelithiasis and C-reactive protein levels supported these findings. Replicated analysis was performed on datasets from the FinnGen Biobank Consortium and East Asian descendants, and similar results were obtained.

Conclusions

This MR analysis suggests that there is no causal association between glucocorticoid use and the risk of pancreatitis.

Intra-articular Steroid Injection as the Etiology of Acute Pancreatitis

Acute interstitial pancreatitis is typically caused by gallstones and alcohol use. Less common causes include infection and drugs. Patients present with epigastric pain and often require pain medications and hospitalization depending on severity. We present a unique case of drug-induced pancreatitis likely caused by intra-articular corticosteroid injections on two separate occasions in the same patient. In both instances, other etiologies were ruled out. Given the temporal relationship between the intra-articular corticosteroid injection and presentation of pancreatitis, the corticosteroid injection was the likely etiology. This case suggests that intra-articular steroids should be included as an etiology of drug-induced pancreatitis.

A Case of Acute Pancreatitis in a Patient Receiving High-Dose Steroids for Optic Neuritis

Although rare, drug-induced pancreatitis is an important cause of acute pancreatitis. The diagnosis of drug-induced pancreatitis remains a challenge for clinicians. Steroids are one of the frequently used drugs in hospitals for many acute illnesses. Patients presenting with signs and symptoms of acute pancreatitis, with a recent history of steroid use, in the absence of other potential causes, should be approached with a high suspicion for steroid-induced pancreatitis to ensure a timely diagnosis. We describe a case of a 57-year-old female treated for optic neuritis of the left eye with high doses of Methylprednisolone for five days, who presented to the emergency room with acute abdominal pain within 24 hours of discharge. A detailed evaluation of the patient's medical history and exclusion of other probable etiologies confirmed the diagnosis of steroid-induced pancreatitis. Withdrawal of the offending agent and supportive care resolved the underlying acute pancreatitis.