From the Guidelines
A decrease in serum lipase levels can be caused by various factors, including chronic pancreatic diseases, severe pancreatic insufficiency, certain medications, genetic disorders, malnutrition, and post-surgical states. Several factors can contribute to a drop in serum lipase levels, such as chronic pancreatic diseases like cystic fibrosis or chronic pancreatitis, where prolonged damage leads to decreased pancreatic enzyme production 1. Severe pancreatic insufficiency from conditions that destroy pancreatic tissue, such as end-stage pancreatic cancer, can significantly reduce lipase production. Certain medications like insulin and oral hypoglycemic agents may lower lipase levels. Genetic disorders affecting pancreatic development or function can result in congenitally low lipase levels. Malnutrition and protein-calorie deficiency can impair enzyme synthesis, as seen in tropical pancreatitis, which is associated with relatively young, undernourished patients 1. Post-surgical states following pancreatic resection naturally reduce lipase-producing tissue. Additionally, laboratory errors in sample handling or processing may falsely indicate low lipase levels. Some key points to consider when evaluating low serum lipase levels include:
- Chronic pancreatic diseases, such as chronic pancreatitis, can lead to decreased pancreatic enzyme production 1
- Severe pancreatic insufficiency can significantly reduce lipase production
- Certain medications, such as insulin and oral hypoglycemic agents, may lower lipase levels
- Genetic disorders affecting pancreatic development or function can result in congenitally low lipase levels
- Malnutrition and protein-calorie deficiency can impair enzyme synthesis
- Post-surgical states following pancreatic resection can naturally reduce lipase-producing tissue
- Laboratory errors in sample handling or processing may falsely indicate low lipase levels Unlike elevated lipase, which often signals acute pancreatitis, low lipase levels generally reflect chronic pancreatic damage or dysfunction rather than acute conditions. If unexpectedly low lipase levels are found, clinicians should consider evaluating for pancreatic insufficiency, which might require pancreatic enzyme replacement therapy, as the gold standard treatment for pancreatic exocrine insufficiency (PEI) is the administration of exogenous enzymes 1.
From the Research
Causes of Decreased Serum Lipase
- There are no direct studies on what causes serum lipase to drop, however, some studies provide insight into the relationship between serum lipase levels and pancreatic function 2.
- Serum lipase levels are often used as a marker for pancreatic disease, and normalization of these levels can be an indicator of improved pancreatic function 2.
- In the context of biliary pancreatitis, proceeding with cholecystectomy after resolution of abdominal pain is equivalent in outcomes to trending serum lipase levels, suggesting that serum lipase levels may not be the only indicator of pancreatic health 2.
- Pancreatic exocrine insufficiency, which can be caused by chronic pancreatitis, can lead to malnutrition and may be managed with pancreatic enzyme supplementation, which could potentially affect serum lipase levels 3, 4, 5.
- Nutritional support and counseling can also play a role in managing pancreatic diseases and improving nutritional status, which may in turn affect serum lipase levels 4, 5.