I am
sure other people have looked at this since. However as part of a small study, I
once examined the amylase isoenzymes in 12 patients with various carcinomas
(amongst other conditions) and two had raised amylase, although only mild
elevations in the hundreds rather than thousands, unlike in your case. One had a
non-Hodgkin's lymphoma and the other had a Ca prostate. In both cases the
amylase was predominantly salivary. (ref. SJ Frost, Clin Chim Acta 87 (1978)
23-28)
I
doubt it applies to your case but there have also been at least one report of
raised predominantly salivary type isoamylase in diabetic ketoacidosis (ref.
Warshaw A. L. et al., Lancet, 1:929, 1977).
Amylase can rise into the thousands in chronic renal failure. It is
typically mixed salivary/pancreatic isoenzymes in this condition. It is possible
to speculate she could have a chronic pancreatitis, which usually lowers the
pancreatic fraction, together with renal failure pushing up the remaining
predominantly salivary fraction. I would be surprised if it would get levels so
high though, even if she has these two conditions.
regards
Steve
Can anyone help? We had a 70 year old lady,
known myeloma with hypercalcaemia admitted with abdominal pain, suspected
pancreatitis. Amylase 4,500 (url < 100). 6/12 later clinically well,
amylase (measured on a number of occasions over the months) remains c
5,000. Abdo U/S and CT show no cysts / deposits in pancreas. Has
high urine amylase output so not macroamylasaemia. Amylase
is non-pancreatic (as per pancreatic lab in MRI) - they measure the
pancreatic isoenzyme so by inference the source is salivary. However, there
is no evidence of salivary gland disease.
I vaguely recall a case report some years ago
where a non-pancreatic, non-salivary amylase elevation was found in a
patient with, I think, some form of malignancy but can't trace it. Any
comment / suggestion welcome.
Thanks
Joe Begley
Poole Hospital
(on the sub-tropical South Coast!)
