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Hypertriglyceridemia (HTG) is an uncommon but well-established etiology of acute pancreatitis (AP) leading to significant morbidity and mortality. Hormone replacement therapy in the transgender population is an underrecognized cause of elevated triglyceride (TG) levels and may put this group at a higher risk for severe pancreatitis. We present a case of AP in a genetically male patient receiving hormone therapy for female gender transformation.A 51-year-old with a past medical history of type 2 diabetes mellitus presented with severe epigastric abdominal pain associated with nonbilious, nonbloody vomiting and anorexia for two days. The patient was diagnosed with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) in the setting of elevated lipase levels of 2,083 u/L and TGs of >5,000 mg/dL. In addition, a computerized tomography scan of the abdomen showed pancreatitis without evidence of necrosis. The patient was admitted to the medical intensive care unit for the management of AP in the setting of elevated TG levels. She was treated with intravenous fluids and an insulin drip. Her home medications including estradiol and Aldactone were held. Once the TG levels were reduced to

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of medications utilized for the treatment of diabetes mellitus by mechanisms promoting incretin release and insulin production. Although poorly understood, cases of acute pancreatitis have been observed in patients taking GLP-1 RAs. Sodium-glucose co-transporter-2 inhibitors (SGLT-2is) are another class of diabetic medications inhibiting renal glucose reabsorption which have been associated with rare cases of euglycemic ketoacidosis. Acute pancreatitis itself has been an observable cause of diabetic ketoacidosis, although typically in a hyperglycemia state. In this case report, we present a patient on SGLT-2is and GLP-1 RAs who developed acute pancreatitis, which may have precipitated euglycemic diabetic ketoacidosis (eu-DKA).