A 56-year-old patient with a history of hypertension, dyslipidemia and bilateral adrenalectomy due to bilateral macronodular hypertrophy of the adrenal glands.
Treatment with losartan and hydrochlorothiazide and topical treatment with hydrochlorothiazide is administered with hydrolytic agents 30 mg/24 hours and fludrosomes 0.1 mg/24 hours.
The patient has a nine-year history of recurrent acute pancreatitis, which manifests as acute episodes of mild intensity that self-limit in about 4-5 days with diet and analgesic treatment.
During her first admission, laboratory tests were performed with normal liver profile and lipid profile with mild elevation of cholesterol (225 mg/dL) and normal TG levels, abdominal ultrasound and cholangio-MRI, in which acute biliary pancreatitis or pancreatic lesions were not identified.
Subsequently, the patient presents new episodes with a periodicity of between seven months and three years, performing in this time analytical studies that are normal and imaging tests including abdominal ultrasound, cholangio-MRI, CT of the abdomen and endoscopic ultrasound.
In the last two years the periodicity is reduced, with episodes every 6-7 months, so that the entire study is repeated again, objectifying in the cholangio-MRI performed a remaining possible origin of chronic adrenal gland corticoids.
An analytical study was performed with cortisol levels of 25.7 mcg/dL, ACTH and normal 24-hour urine cortisol. The dose of corticosteroids per day was reduced to progressive suspension of steroids, which were up to 10 mg.
In addition, due to the possibility of pharmacological origin, antihypertensive treatment is changed from the combination of losartan and hydrochlorothiazide to raipryl alone.
The etiologic study was completed with normal levels of IG4 and ANA, sweat test and genetic testing for cystic fibrosis that are negative.
Six months after the treatment modification, the patient was readmitted for mild acute pancreatitis.
The patient is questioned again, who finally refers to the regular consumption of horsetail infusions.
The possibility of recurrent pancreatitis secondary to the administration of this infusion is completely suspended.
Since then, 14 months later, the patient has remained asymptomatic with normal controls and controls.
