Nonspecific hyperamylasemia: a case report.

CONTEXT: The elevation of serum amylase and lipase are generally associated with pancreatic diseases. However they can be associated with different pathologies unrelated with amylase and lipase. CASE REPORT: This paper aims to report a case of a patient diagnosed with nonspecific hyperamylasemia and warn of this possibility in the differentiation of hyperamylasemia. CONCLUSION: The correct diagnosis of silent hyperamylasemia is important in order to determine whether there is the risk of pancreatic disease or if we are just ahead of a benign hyperenzymemia.

Elderly lady with ascites.

An elderly lady with amylase-rich ascites is presented, whose isoenzyme estimation revealed salivary type amylase. Tumour hyperamylasemia is an important group among the nonpancreatic causes of elevated amylase.

Lipase and pancreatic amylase activities in diagnosis of acute pancreatitis in patients with hyperamylasemia.

BACKGROUND: Measurement of total serum amylase (AMY) is the most widely used biochemical test for the diagnosis of acute pancreatitis, but it is commonly considered a nonspecific marker. To improve the biochemical diagnosis of acute pancreatitis, lipase (LIP) and pancreatic amylase (PAMY) have been tested in recent years. The present study was designed to evaluate whether serum LIP and pancreatic PAMY tests could replace total amylase test to improve diagnostic efficiency in the evaluation of acute pancreatitis in patients with hyperamylasemia. METHODS: LIP and PAMY values were determined in serum samples from 92 patients with hyperamylasemia. Reference values for each enzyme were derived from serum samples of 147 healthy subjects. The activities of LIP and PAMY in patients with various diseases were shown directly by the boxplot graph. The diagnostic accuracy of LIP and PAMY was defined as the area under the receiver operating characteristic (ROC) curve. Their sensitivity and specificity in detecting acute pancreatitis at varying cutoff points were shown by the curve, and the best cutoff value for each enzyme was shown by the modified ROC curve. The diagnostic values of LIP, PAMY and LIP+AMY with each upper limit of reference range (ULR) were compared with the corresponding best cutoff values. RESULTS: The references values of LIP and PAMY were 12.2-47.6 U/L and 28-95 U/L, respectively. These values in patients with acute pancreatitis were higher than those patients with other diseases. The areas under the ROC curve (AUC) of LIP and PAMY were 0.799 and 0.792, respectively. With the best diagnostic cutoff point of maximum (sensitivity + specificity)-100%, we obtained values of 97.9 U/L (LIP(97.9)=2.06 X ULR) for LIP and 209 U/L (PAMY(209)=2.20 X ULR) for PAMY. The best cutoff values for LIP, PAMY and LIP+AMY demonstrated the specificity, positive predictive value, and diagnostic efficiency higher than the corresponding ULRs. CONCLUSIONS: Serum LIP and PAMY are specific for the pancreas and might replace total amylase for the diagnosis of acute pancreatitis in hyperamylasemia patients. LIP(97.9) is more efficient than PAMY(209) in the diagnosis of acute pancreatitis. A combined test of both enzymes is not superior to single test of either enzyme in diagnostic accuracy.

Hyperamylasaemia and multiple myeloma.

This case report describes a 42-year-old Caucasian woman who presented with persistent hyperamylasaemia and no evidence of pancreatic pathology. Further investigations resulted in a diagnosis of light-chain multiple myeloma. Amylase production by epithelial tumours has been well documented but the association with multiple myeloma has only been described in a small number of cases. The link does not appear to be immunoglobulin class-specific but the association with Bence Jones myeloma is unusual. The common features in this group of patients have been extensive extramedullary spread with a high tumour mass and a poor prognosis. This case was similar in that the patient showed very rapid disease activity developing extensive metastatic lesions and treatment ultimately proved unsuccessful. The amylase concentrations have been shown to decrease in response to treatment and increase at times of relapse and it has been proposed that it may be useful as a tumour marker in these patients. This case study adds to the pool of patents with this unusual association.

Clinical significance of chronic hyperamylasemia.

A longitudinal study of patients with persistent hyperamylasemia was carried out to evaluate the clinical significance of this condition. Twenty-five outpatients were studied by means of serum amylase, isoamylase (wheat germ-inhibition method), and lipase determination; macroamylase detection; and abdominal ultrasonography over a one-year period. Cellulose acetate electrophoresis was carried out to validate the wheat germ-inhibition tests; the results of the two assays were closely correlated, except in three patients with macroamylasemia. At the time of the study, none of the patients had evident signs or symptoms of pancreatic disease. At initial evaluation, wheat germ test demonstrated an elevation of only salivary isoamylase in 16 patients, both pancreatic and salivary isoenzyme in two, and only pancreatic isoamylase in six patients (three with macroamylasemia). Normal salivary and pancreatic isoenzymes were found in one with predominantly pancreatic isoamylase. At the 12-month follow-up, hyperamylasemia had disappeared in six cases and salivary isoamylase elevation in three; pancreatic isoamylase remained abnormally high in all eight patients in whom it was elevated at initial evaluation, and lipase was abnormally high in three patients with elevated pancreatic isoamylase. Of the five patients with true pancreatic hyperamylasemia, one had a juxtapapillary duodenal diverticulum, one showed a slight ultrasound alteration of the pancreas, and one had a past history of acute pancreatitis. In our study, most cases of chronic hyperamylasemia were of nonpancreatic origin. In the patients with elevated pancreatic isoamylase, there was no clinical evidence of pancreatic damage, although a subclinical pancreatic involvement could not be excluded in some.