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
Consultant Clinical Biochemist
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