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Hi John Amylase clearance is not definitive - perhaps one of the reasons it has gone out of fashion - but helpful. 1.6% is borderline. Abdominal (and chest) imaging is quite important as we picked up an Ovarian tumour on someone who had been labelled as having pancreatitis (acute/subacute/relapsing/ chronic at various stages). http://www.bmj.com/content/331/7521/890.full.pdf Literature is studded (infrequently) with tumoral production of amylase. Can't explain the slightly high Lipase; may turn out to be a pancreatic pathology after all. Regards Rajeev Rajeev Srivastava Consultant Clinical Biochemist Royal Hospital for Sick Children Glasgow ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of O'Connor John (Royal Devon and Exeter Foundation Trust) Sent: 17 August 2011 11:37 To: [log in to unmask] Subject: Macroamylasaemia Dear Collective We have a 66y F who presented in May last year with right upper quad abdo pain and general abdo discomfort with an amylase of 171 u/l NR (28-100) LFT's , U+E, CRP Lipids all normal. Her abdo symptoms disappeared (no other investigations performed, never ultrasound scanned) Her amylase persists to be raised to this day (168,158,264,215,198,2110) We did a macroamylase check using standard protocol below The formula is (urine amylase x serum creatinine) / (serum amylase x urine creatinine) x 100. The normal range is 2-5%. In Macroamylasemia the ratio is usually less than 2% She gave a value of 1.6% so we thought we had nailed it, but.................... Her Lipase has come back at 75 u/l top of the range being 70 . The only other slightly unusual feature is a persistently low alkaline phosphatase which runs 40 -45 u/l Any thoughts Cheers John ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ******************************************************************************************************************** This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. NHSmail is the secure email and directory service available for all NHS staff in England and Scotland NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients NHSmail provides an email address for your career in the NHS and can be accessed anywhere For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail ******************************************************************************************************************** ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/