A Systematic Approach to Patients with Elevated Levels of Serum Amylase or Lipase

Abstract

Serum amylase and lipase tests are routinely performed in patients presenting with abdominal pain or even during regular health screening. Elevated serum levels of these two enzymes are often encountered in clinical practice. The differential diagnosis is broad and includes acute pancreatitis, chronic pancreatitis, gastrointestinal tract obstruction, malignancies, and other disease conditions. In this article, we review the pathophysiology of elevated amylase and lipase, possible conditions that cause the increase, and diagnostic strategies for such patients. We conclude that a systematic approach to patients with elevated amylase and/or lipase is critical to making an accurate diagnosis and initiating appropriate treatment.

Macroamylasemia versus Hyperamylasemia

“…1) As macroamylasemia is estimated to affect approximately 1% of the general population and 2.5% of people with hyperamylasemia, the possibility of misdiagnosis with pancreatitis is high; therefore, the objective of the following comments is to enhance the suspicion index. [2][3][4][5] Čásenská et al 2) studied 13 asymptomatic individuals with a mean age of 40.8 years with isolated macroamylasemia without pancreatic disease and normal renal function. Macroamylase was confirmed in five of them by the polyethylene glycol precipitation (PEG) method, and the polyethylene glycol precipitation activity (%PPA) in suspected patients was 89.1% for amylase and 84.3% for pancreatic amylase.…”

“…Choi 3) reviewed the mechanisms underlying elevated serum amylase and lipase levels, associated conditions, and diagnostic resources for managing these patients. In macroamylasemia, a combination of amylase with large molecules acts as an example of immunoglobulins and polysaccharides, propitiating lower renal excretion and accumulation in the bloodstream, increasing serum amylase levels.…”

“…In macroamylasemia, a combination of amylase with large molecules acts as an example of immunoglobulins and polysaccharides, propitiating lower renal excretion and accumulation in the bloodstream, increasing serum amylase levels. 3) The author cited a study that included 2,900 patients with hyperamylasemia, and approximately 9.6% of them presented with macroamylasemia, which is more frequently asymptomatic, although it may be found in individuals with abdominal pain, nausea, vomiting, or diarrhea. 3) Other associated causes include systemic lupus erythematosus, rheumatoid arthritis, Sjögren's disease, Crohn's disease, celiac disease, ulcerative colitis, immunoglobulin A deficiency, monoclonal gammopathy, myasthenia gravis, and human immunodeficiency virus infection.…”

“…3) The author cited a study that included 2,900 patients with hyperamylasemia, and approximately 9.6% of them presented with macroamylasemia, which is more frequently asymptomatic, although it may be found in individuals with abdominal pain, nausea, vomiting, or diarrhea. 3) Other associated causes include systemic lupus erythematosus, rheumatoid arthritis, Sjögren's disease, Crohn's disease, celiac disease, ulcerative colitis, immunoglobulin A deficiency, monoclonal gammopathy, myasthenia gravis, and human immunodeficiency virus infection. 3) Dedeene et al 4) evaluated the upper reference limits (URLs) for amylase, creatine kinase, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, lactate dehydrogenase, and lipase after PEG precipitation to detect macroenzymes and found adequate within-lab precision for all these enzymes.…”