Unexplained elevation in serum pancreatic enzymes

Background and aims: Considerably elevated levels of serum amylase and/or lipase are generally diagnostic of acute pancreatitis. We describe two cases associated with marked hyperamylasemia and hyperlipasemia, but without any evidence of pancreatic disease.

Patients and results: A young male and a female patient had earlier been admitted to local hospitals with ulcerous and dyspeptic complaints. In both cases, the serum and urinary amylase levels were elevated, and these findings led to the erroneous diagnosis of acute pancreatitis. Hyperamylasemia had not been previously detected in either case. They both had a negative clinical history and neither of them was a smoker or a drinker. Treatment was started for acute pancreatitis. Their complaints abated, but the serum pancreatic enzyme levels remained markedly elevated. They were therefore referred to our tertiary center, where the serum and urinary amylase and serum lipase levels proved to be elevated. Because of the absence of pain and the normal abdominal computer tomography picture, neither patient was hospitalized. Both of them remained free of complaints during the 12-month follow-up. The enzyme concentrations remained highly elevated, though with wide fluctuations, and transient normalization was occasionally observed. Repeated abdominal ultrasonography and magnetic resonance cholangiopancreatography revealed a normal pancreas. Upper endoscopy demonstrated a normal main papilla, but with erosions in the duodenal bulb of the male patient and reflux esophagitis in the female patient. Treatment with a proton pump inhibitor and Helicobacter pylori eradication did not lead to normalization of the pancreatic enzyme levels in the serum in either case. The sweat chloride concentration and exocrine pancreatic function were normal in both subjects.

Conclusions: The possibility of hyperamylasemia and hyperlipasemia without pancreatic disease should be borne in mind, so as to avoid a misdiagnosis and unnecessary, often costly diagnostic and therapeutic activity. Hyperenzimemia might be cause by an increased rate of entry of pancreatic enzymes into circulation.