From the Guidelines
Elevated lipase levels are primarily caused by pancreatic inflammation or damage, with acute pancreatitis being the most common cause, often resulting from gallstones or alcohol abuse, as supported by the 2019 WSES guidelines 1. The causes of elevated lipase levels can be multifaceted, including:
- Acute pancreatitis
- Chronic pancreatitis
- Pancreatic cancer
- Pancreatic duct obstruction
- Kidney disease
- Certain medications like opiates, steroids, and some antibiotics Lipase is an enzyme produced mainly by the pancreas to help digest fats, and when pancreatic cells are damaged, lipase leaks into the bloodstream. Normal lipase levels typically range from 0-160 U/L, though reference ranges vary between laboratories. Levels three times the upper limit strongly suggest pancreatic disease, as indicated by the AGA Institute medical position statement on acute pancreatitis 1. Symptoms accompanying elevated lipase may include severe abdominal pain, nausea, vomiting, and fever. If elevated lipase is detected, medical evaluation is necessary to determine the underlying cause, which may require imaging studies like CT scans or ultrasound, as recommended by the WSES-AAST guidelines 1. Treatment depends on identifying and addressing the specific cause rather than treating the elevated lipase itself. It is essential to consider other potential causes of elevated lipase, such as hypertriglyceridemia, which can increase the risk of pancreatitis, as noted in the Endocrine Society guidelines 1. In the absence of gallstones or significant history of alcohol use, serum triglyceride should be measured and considered to be the etiology if the value is > 11.3 mmol/l (> 1000 mg/dl) 1. Overall, a comprehensive approach is necessary to diagnose and manage elevated lipase levels, taking into account the various potential causes and underlying conditions.
From the Research
Causes of Elevated Lipase Levels
Elevated lipase levels can be caused by various factors, including:
- Pancreatitis, although it is not the only possible cause 2, 3, 4, 5, 6
- Non-pancreatic sources of lipolytic enzymes due to malignant tumors 5
- Renal insufficiency, which can reduce the clearance of lipase 3, 5
- Acute cholecystitis or esophagitis 5
- Hypertriglyceridemia 5
- Delayed blood withdrawal, which can affect lipase levels 5
- Infectious colitis, as reported in a case study 2
- Critical illness, including neurosurgical pathology 3
- Diabetes, drugs, and infections, which can also cause elevated lipase levels 3
Differential Diagnoses
It is essential to consider alternative diagnoses when encountering elevated lipase levels, as they may not always indicate pancreatitis 2, 3, 4, 5, 6. A systematic review found various causes of significant serum lipase elevations, including reduced clearance of lipase, other hepatobiliary, gastroduodenal, intestinal, and neoplastic causes, critical illness, and alternative pancreatic diagnoses 3.
Diagnostic Accuracy
A serum lipase level > 3 times the upper limit of normal has a high diagnostic accuracy for acute pancreatitis, with a sensitivity of 100% and a specificity of 99% 6. However, it is crucial to interpret lipase levels in conjunction with other clinical findings and laboratory results to avoid misdiagnosis 2, 3, 4, 5, 6.