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. 2020 Oct 28;7(12):001956.
doi: 10.12890/2020_001956. eCollection 2020.

Angiotensin-Converting Enzyme (ACE) Inhibitors and Pancreatitis: A Potential Dose-dependent Relationship

Murtaza S Hussain  1 , Smit S Deliwala  1 , Anoosha Ponnapalli  1 , Viraj Modi  2 , Ashok Kanugula  1 , Mamoon M Elbedawi  3 , Ghassan Bachuwa  1
Affiliations

Angiotensin-Converting Enzyme (ACE) Inhibitors and Pancreatitis: A Potential Dose-dependent Relationship

Murtaza S Hussain et al. Eur J Case Rep Intern Med. .

Abstract

Acute pancreatitis (AP) remains one of the most common causes of emergency department visits in the USA. The literature supports an association between angiotensin-converting enzyme inhibitors (ACEi), mainly at steady-state doses, and AP[1]. We present a case of recurrent AP and pseudocyst formation following multiple ACEi dose adjustments after a steady-state period lasting for over a decade. Previous reports have rarely described ACEi-induced pancreatitis and pseudocyst development. ACEi can cause significant ductal obstruction[2] and fluid retention due to its angioedema effects. Consequently, it may trigger AP complicated by pseudocyst formation. Therefore, ACEi administration must be considered in the appropriate clinical context.

Learning points: Although rare, ACEi is an emerging cause of drug-induced pancreatitis and often goes unrecognized.Multiple dose changes within a short period of time can lead to acute drug-induced pancreatitis (DIP), in addition to classic DIP caused by steady-state doses.ACEi-induced angioedema damages the ductal architecture and also has longer-lasting effects such as pseudocyst formation.

Keywords: ACEi; Acute pancreatitis; drug-induced pancreatitis; lisinopril; recurrent acute pancreatitis.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
Computed tomography (CT) of the abdomen, revealing a 1.5 cm hypodensity in the pancreatic body consistent with a pseudocyst
Figure 2
Figure 2
Magnetic resonance cholangiopancreatography (MRCP) with Omniscan revealing a 1.7 cm×1.4 cm hypoenhancement with a central cystic component
See this image and copyright information in PMC

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