The many faces of hyperamilasemia: clinical observations

Background. Hyperamilasemia is a laboratory sign, which in most cases serves as a marker of pancreatic diseases of an inflammatory, traumatic, and tumor nature. However, in some cases, the high activity of blood amylase is combined with the normal urine amylase level and is not accompanied by other symptoms. In such cases, there is a suggestion of macroamylasemia. The diagnosis of macroamylasemia is difficult due to the lack of a standardized algorithm, the complexity of its implementation, and discrepancies in the interpretation of laboratory tests. Series of clinical observations. Approaches to the differential diagnosis of various variants of hyperamilasemia are presented using clinical examples. The first clinical example (patient A.), describes the significance of the amylase level in the diagnosis of pancreatic disease. The second clinical observation (patient B.) is a case of long-term asymptomatic hyperamilasemia. After additional examination, type 1 macroamylasemia was diagnosed. The mechanisms of increasing the amylase level in various conditions are described. Conclusion. In patient A., hyperamilasemia was considered as an important diagnostic sign indicating the structural pathology of the pancreas. In patient B., the cause of hyperamilasemia was macroamylasemia - a non-life-threatening biochemical anomaly that requires a detailed examination, broad differential diagnosis, but does not require treatment. This information is important to prevent overdiagnosis of chronic pancreatitis.

hyperamilasemia, macroamylasemia, chronic pancreatitis