Gebelikte Pankreas Hastalıklarının Yönetimi
Özet
Gebelik döneminde pankreas hastalıkları nadir görülse de artan anne yaşı ve ek hastalıklar nedeniyle sıklığı artmaktadır. Gebelikte pankreasın endokrin fonksiyonu glukoz metabolizmasına uyum sağlamak için beta hücre hipertrofisiyle değişirken, ekzokrin fonksiyonlar büyük ölçüde sabit kalır. Akut pankreatit (AP), 1000-10.000 gebelikte bir görülür ve en yaygın etiyoloji safra taşı hastalığıdır; özellikle üçüncü trimesterde insidans artar. Tanıda karın ağrısı, serum lipaz/amilaz yüksekliği ve ultrason gibi görüntüleme yöntemleri kullanılır; tedavi ise genellikle konservatif yöntemlerle başlar. Safra taşı kaynaklı vakalarda ikinci trimester, cerrahi müdahale için en güvenli dönemdir. Hipertrigliseridemi ise gebelikte %50'ye varan oranlarda şiddetli AP vakalarından sorumlu olabilir ve diyet, omega-3 veya plazma değişimi ile yönetilir. Kronik pankreatit, kistik neoplazmalar ve pankreas kanseri gebelikte oldukça nadirdir; ancak kanser vakalarında tanı genellikle spesifik olmayan semptomlar nedeniyle gecikir. Bu tür durumlarda tedavi stratejisi, hastalığın evresine ve gebelik haftasına göre multidisipliner bir yaklaşımla belirlenir. Sonuç olarak, gebelikte pankreas hastalıklarının erken teşhisi ve yönetimi, maternal ve fetal komplikasyon riskini azaltmak için kritik öneme sahiptir.
Pancreatic disorders during pregnancy are relatively rare, but their frequency is increasing due to advancing maternal age and comorbid conditions. While the endocrine function of the pancreas adapts through beta-cell hypertrophy to manage glucose metabolism, exocrine functions remain largely unchanged. Acute pancreatitis (AP) occurs in 1 in 1,000 to 10,000 pregnancies, primarily caused by gallstone disease, with incidence peaking in the third trimester. Diagnosis relies on abdominal pain, elevated serum lipase/amylase levels, and imaging like ultrasound, while treatment typically begins with conservative measures. For gallstone-related cases, the second trimester is the preferred period for surgical intervention. Hypertriglyceridemia can account for up to 50% of severe AP cases in pregnancy and is managed via diet, omega-3 supplements, or plasma exchange. Chronic pancreatitis, cystic neoplasms, and pancreatic cancer are exceedingly rare during pregnancy, though cancer diagnosis is often delayed due to non-specific symptoms. In such cases, treatment strategies are determined by the stage of the disease and gestational age using a multidisciplinary approach. Ultimately, early diagnosis and management of pancreatic disorders are critical to reducing the risk of maternal and fetal complications.
Referanslar
Huang C, Snider F, Cross JC. Prolactin receptor is required for normal glucose homeostasis and modulation of beta-cell mass during pregnancy. Endocrinology. 2009;150:1618–1626.
Karsenti D, Bacq Y, Brechot JF, et al. Serum amylase and lipase activities in normal pregnancy: a prospective case-control study. Am J Gastroenterol. 2001;96:697–699.
Igbinosa O, Poddar S, Pitchumoni C. Pregnancy associated pancreatitis revisited. Clin Res Hepatol Gastroenterol. 2013;37:177–181.
Tang M, Xu JM, Song SS, et al. What may cause fetus loss from acute pancreatitis in pregnancy: analysis of 54 cases. Medicine. 2018;97:e9755.
Tang SJ, Rodriguez-Frias E, Singh S, et al. Acute pancreatitis during pregnancy. Clin Gastroenterol Hepatol. 2010;8:85–90
Wilcox CM, Varadarajulu S, Eloubeidi M. Role of endoscopic evaluation in idiopathic pancreatitis: a systematic review. Gastrointest Endosc. 2006;63:1037–1045.
Everson GT, McKinley C, Lawson M, et al. Gallbladder function in the human female: effect of the ovulatory cycle, pregnancy, and contraceptive steroids. Gastroenterology. 1982;82: 711–719.
Ko CW, Beresford SA, Schulte SJ, et al. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology. 2005;41:359–365.
Date RS, Kaushal M, Ramesh A. A review of the management of gallstone disease and its complications in pregnancy. Am J Surg. 2008;196: 599–608.
Hernandez A, PetrovMS, Brooks DC, et al. Acute pancreatitis and pregnancy: a 10-year single center experience. J Gastrointest Surg. 2007;11:1623–1627.
Sedaghat N, Cao AM, Eslick GD, et al. Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis. Surg Endosc. 2017;31:673–679.
Inamdar S, Berzin TM, Sejpal DV, et al. Pregnancy is a risk factor for pancreatitis after endoscopic retrograde cholangiopancreatography in a national cohort study. Clin Gastroenterol Hepatol. 2016;14:107–114.
Desoye G, Schweditsch MO, Pfeiffer KP, et al. Correlation of hormones with lipid and lipoprotein levels during normal pregnancy and postpartum. J Clin Endocrinol Metab. 1987;64:704–712.
Padmanabhan A, Connelly-Smith L, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis: the eighth special issue. J Clin Apher. 2019;34:171–354.
Huang C, Liu J, Lu Y, et al. Clinical features and treatment of hypertriglyceridemia-induced acute pancreatitis during pregnancy: a retrospective study. J Clin Apher. 2016;31:571–578.
Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148: 824.e822–848.e822.
Herring AA, Graubard MB, Gan SI, et al. Mucinous cystadenocarcinoma of the pancreas during pregnancy. Pancreas. 2007;34:470–473.
Wiseman JE, Yamamoto M, Nguyen TD, et al. Cystic pancreatic neoplasm in pregnancy: a case report and review of the literature. Arch Surg. 2008;143:84–86.
Tica AA, Tica OS, Saftoiu A, et al. Large pancreatic mucinous cystic neoplasm during pregnancy: what should be done? Gynecol Obstet Invest. 2013;75:132–138.
Khorana AA, Mangu PB, Berlin J, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34:2541–2556.
