Serial Cross-Sectional Imaging of Necrotizing Pancreatitis secondary to Ozempic (semaglutide) use
Poster #: 063
Session/Time: B
Author:
Kevin James Moran, MS
Mentor:
Frances Lazarow, MD
Research Type: Case Report
Abstract
INTRODUCTION:
Necrotizing pancreatitis is a rare but well-documented complication of glucagon-like peptide-1 receptor agonists (GLP-1 RAs). In June 2021, the U.S. Food and Drug Administration (FDA) approved semaglutide (Wegovy) for weight loss, followed by tirzepatide (Zepbound) in November 2023. By 2025, an estimated 6% of U.S. adults, over 15 million Americans, are prescribed a GLP-1 RA for weight loss and obesity management. Between 2019 and 2024, prescriptions for GLP-1 agents increased by nearly 600%. Among patients prescribed GLP-1 RAs without type 2 diabetes, the diagnosis of co-occurring pancreatitis increased 80% from 2022 to 2024. Although prevalence remains low, this represents a concerning rise in pancreatitis diagnoses. We present the case of a 66-year-old woman who developed fatal necrotizing pancreatitis secondary to semaglutide (Ozempic). This report emphasizes the radiologic progression of pancreatic necrosis on serial CT and MRI imaging during a protracted hospital course.
CASE INFORMATION:
A 66-year-old woman with uncomplicated T2DM well controlled on oral agents and mild hyperlipidemia presented with acute severe epigastric pain, nausea, and vomiting. She had no history of obesity, gallstones, alcohol use, pancreatotoxic medications, or hypertriglyceridemia. Notably, semaglutide had been initiated approximately six weeks earlier for glycemic optimization. Laboratory evaluation confirmed elevated pancreatic enzymes. Cross-sectional imaging revealed extensive pancreatic and peripancreatic necrosis without biliary obstruction or cholelithiasis. Despite aggressive resuscitation, she developed infected necrotizing pancreatitis confirmed by positive cultures from peripancreatic collections. Her clinical course was complicated by recurrent sepsis, multi-organ failure, and multiple minimally invasive and surgical interventions. After a four-month hospitalization, she died from complications. Serial CT and MRI documented the progression from interstitial pancreatitis to extensive necrosis, underscoring the central role of imaging in diagnosis and management.
DISCUSSION:
This case demonstrates a rare but catastrophic outcome of GLP-1 RA-associated pancreatitis in a patient without gallstones, obesity, alcohol use, or severe hypertriglyceridemia. The absence of conventional risk factors supports the possibility of direct drug-mediated pancreatic injury rather than an indirect effect of rapid weight loss or gallbladder dysfunction. While semaglutide clinical trials in diabetes populations report pancreatitis rates comparable to placebo, real-world data suggest otherwise. A 2023 U.S. claims analysis of weight-loss patients indicated increased risk. The lack of traditional risk factors in this patient further supports the potential for GLP-1 RAs to precipitate direct pancreatic injury. Radiology plays a critical role in both diagnosis and management of necrotizing pancreatitis. In this case, serial CT and MRI imaging documented the rapid transition to necrosis, guided drainage and surgical planning, and monitored complications such as infected collections.
CONCLUSION:
This case illustrates the rising occurrence of pancreatitis in patients receiving GLP-1 RAs, demonstrated through detailed radiologic imaging. With the sharp increase in prescriptions from 2021-2025, prevalence of pancreatitis and related complications will likely continue to grow. Clinicians should remain alert to the potential for severe pancreatitis, including infected necrosis, even in patients without conventional risk factors. Prompt discontinuation, early recognition, and multidisciplinary management are essential. Radiology is pivotal in recognizing necrotizing pancreatitis and guiding minimally invasive interventions. Ongoing pharmacovigilance, case aggregation, and additional studies are needed to further clarify the causal relationship between GLP-1 RAs and pancreatic injury.
Necrotizing pancreatitis is a rare but well-documented complication of glucagon-like peptide-1 receptor agonists (GLP-1 RAs). In June 2021, the U.S. Food and Drug Administration (FDA) approved semaglutide (Wegovy) for weight loss, followed by tirzepatide (Zepbound) in November 2023. By 2025, an estimated 6% of U.S. adults, over 15 million Americans, are prescribed a GLP-1 RA for weight loss and obesity management. Between 2019 and 2024, prescriptions for GLP-1 agents increased by nearly 600%. Among patients prescribed GLP-1 RAs without type 2 diabetes, the diagnosis of co-occurring pancreatitis increased 80% from 2022 to 2024. Although prevalence remains low, this represents a concerning rise in pancreatitis diagnoses. We present the case of a 66-year-old woman who developed fatal necrotizing pancreatitis secondary to semaglutide (Ozempic). This report emphasizes the radiologic progression of pancreatic necrosis on serial CT and MRI imaging during a protracted hospital course.
CASE INFORMATION:
A 66-year-old woman with uncomplicated T2DM well controlled on oral agents and mild hyperlipidemia presented with acute severe epigastric pain, nausea, and vomiting. She had no history of obesity, gallstones, alcohol use, pancreatotoxic medications, or hypertriglyceridemia. Notably, semaglutide had been initiated approximately six weeks earlier for glycemic optimization. Laboratory evaluation confirmed elevated pancreatic enzymes. Cross-sectional imaging revealed extensive pancreatic and peripancreatic necrosis without biliary obstruction or cholelithiasis. Despite aggressive resuscitation, she developed infected necrotizing pancreatitis confirmed by positive cultures from peripancreatic collections. Her clinical course was complicated by recurrent sepsis, multi-organ failure, and multiple minimally invasive and surgical interventions. After a four-month hospitalization, she died from complications. Serial CT and MRI documented the progression from interstitial pancreatitis to extensive necrosis, underscoring the central role of imaging in diagnosis and management.
DISCUSSION:
This case demonstrates a rare but catastrophic outcome of GLP-1 RA-associated pancreatitis in a patient without gallstones, obesity, alcohol use, or severe hypertriglyceridemia. The absence of conventional risk factors supports the possibility of direct drug-mediated pancreatic injury rather than an indirect effect of rapid weight loss or gallbladder dysfunction. While semaglutide clinical trials in diabetes populations report pancreatitis rates comparable to placebo, real-world data suggest otherwise. A 2023 U.S. claims analysis of weight-loss patients indicated increased risk. The lack of traditional risk factors in this patient further supports the potential for GLP-1 RAs to precipitate direct pancreatic injury. Radiology plays a critical role in both diagnosis and management of necrotizing pancreatitis. In this case, serial CT and MRI imaging documented the rapid transition to necrosis, guided drainage and surgical planning, and monitored complications such as infected collections.
CONCLUSION:
This case illustrates the rising occurrence of pancreatitis in patients receiving GLP-1 RAs, demonstrated through detailed radiologic imaging. With the sharp increase in prescriptions from 2021-2025, prevalence of pancreatitis and related complications will likely continue to grow. Clinicians should remain alert to the potential for severe pancreatitis, including infected necrosis, even in patients without conventional risk factors. Prompt discontinuation, early recognition, and multidisciplinary management are essential. Radiology is pivotal in recognizing necrotizing pancreatitis and guiding minimally invasive interventions. Ongoing pharmacovigilance, case aggregation, and additional studies are needed to further clarify the causal relationship between GLP-1 RAs and pancreatic injury.