From the clinical information given in this case, the
high level of serum amylase and its temporal decline
point towards an acute event as explained earlier.
Other causes of raised amylase are unlikely to be
relevant in this case. A repeat serum amylase today or
tomorrow may show further decline and it may take few
days to return back to normal in cases of parotitis.
regards
Mohammad
--- "Frost, Stephen"
<[log in to unmask]> wrote: >
Isoamylase that migrates like salivary amylase has
> been found in several
> tissues including the mammary gland, ovary and
> fallopian tube (e.g. Skude G
> et al. Am J Obstet Gyn 1976, 126, 652-6). This
> isoamylase doesn't normally
> contribute to serum amyase significantly, but it was
> proposed that it could
> in disease states such as D. ketoacidosis. I have
> seen slight elevations of
> salivary type in a non-ketotic diabetic patient (2x
> normal), a non-Hodgekins
> lymphoma and incidentally a Ca prostate, but nothing
> like this high. On the
> other hand I only looked specifically at these
> groups of patients(e.g.
> tumours) over a few months for a study, so don't
> know how common it may be.
> May or may not be relevant to this case.
>
>
> regards
>
> Steve Frost
>
> -----Original Message-----
> From: Mohammad Al-Jubouri
> [mailto:[log in to unmask]]
> Sent: Wednesday, October 08, 2003 10:00 AM
> To: [log in to unmask]
> Subject: Re: Raised amylase
>
>
> An interesting case of hyperamylasaemia? cause!
> A normal lipase and an ACCR of <5% have effectively
> excluded acute pancreatitis.
> A significan decline of serum amylase level over 24h
> and an ACCR of >1% have effectively excluded
> macroamylasaemia.
> What remained is parotitis (asymptomatic mumps). Up
> to
> 20% of mumps infections are asymptomatic and an
> additional 40%-50% may have only nonspecific or
> primarily respiratory symptoms as happend in this
> case.
> Amylase isoenzyme analysis is interesting to perform
> on these samples to see if it shows predominant
> S-isoamylase isoenzyme. An update on this case would
> be appreciated.
>
> regards
>
> Mohammad
>
>
> --- Steven Mccann
> <[log in to unmask]>
> wrote: > Dear List members,
> >
> > Some help with the following case would be warmly
> > received.
> >
> > A 32 year old and 32 week pregnant Asian lady
> > presented at our A&E department with a short
> history
> > of coughing and vomiting. Her only past medical
> > history is that she is a type 2 diabetic, she did
> > not have any abdo pain on presentation. Her
> recent
> > glucose control has been good with levels between
> 4
> > and 6 mmol/L, she has no ketones in her urine.
> The
> > A&E Doctor in error requested an Amylase which
> came
> > back as 2818U/L, (normal <100) her other U&E and
> > LFT's were all normal. A lipase carried out on
> the
> > same sample was normal 39 (<40)
> > Further samples were received on the patient with
> > the following amylase and lipase results
> > Time Amylase Lipase
> > 06/10/03 2am 2818 39
> > 06/10/03 9am 1481 31
> > 06/10/03 5.30pm 1620 37
> > 07/10/03 00.30am 1928 41
> > 07/10/03 11.17am 1161 41
> >
> > To exclude macroamylasaemia urine samples were
> sent.
> >
> > A urine sample was received at 12.30pm on the
> > 06/10/03, the amylase and creatinine results were
> > 3220 u/L and 6.6 mmol/L respectively. The nearest
> > blood sample to this urine was 9am, where the
> > amylase and creatinine were 1481 and 0.65mmol/L
> > respectively. The calculated amylase clearance
> was
> > 2.13%. Depending on your reference range this is
> > normal, however levels tend to be high in
> > pancreatitis.
> >
> > Another urine was received at 3pm on the 06/10/03
> > the amylase and creatinine results were 1964 u/L
> and
> > 4.5mmol/L respectively. The closest blood sample
> > (5.30pm) to this urine had an amylase and
> creatinine
> > of 1620 and 0.06mmol/L and gave a clearance of
> 1.8%,
> > which is slightly low but not as low as the values
> I
> > have previously seen in macroamylasaemia usually
> > 0.05%.
> >
> > The patient was sent for a CT scan to try to image
> > the pancreas, however due to pregnancy the gland
> > could not be seen.
> >
> > The patient was then managed as if having
> > pancreatitis, i.e 'drip and suck' (nil by mouth,
> on
> > a dextrose saline drip and a nasogastric tube to
> > drain gastric fluid). Due to the low clinical
> > suspicion of pancreatitis and her pregnant state
> she
> > was allowed to eat by mouth at noon on 07/10/03.
> >
> > Any thoughts on the causes of the raised amylase,
> we
> > are currently using the Roche P units for general
> > chemistry?
> >
> >
> >
> >
> > Steven McCann
> > Senior Clinical Scientist
> > Department of Clinical Biochemistry
> > Wythenshawe Hospital
> > Southmoore Road
> > Wythenshawe
> > Manchester, M23 9LT
> >
> > Tel. no. 0161 291 4794
> > Fax. no. 0161 291 2927
> >
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> > community working in clinical biochemistry.
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>
> =====
> Dr. M A Al-Jubouri
> Consultant Chemical Pathologist
>
>
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Consultant Chemical Pathologist
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