From the Guidelines
Hyperamylasemia is primarily caused by acute pancreatitis (AP).
Causes of Hyperamylasemia
- Acute Pancreatitis (AP): The leading cause of hyperamylasemia, where amylase levels rise within 6 to 24 hours, peak at 48 hours, and decrease to normal or near normal levels over the next 3 to 7 days 1.
- Other sources of amylase: Amylase is also secreted by salivary glands, small intestine, ovaries, adipose tissue, and skeletal muscles, which can contribute to hyperamylasemia in certain conditions.
Diagnosis of Hyperamylasemia
- Serum amylase measurement: Considered the "gold standard" for the diagnosis of AP, with a sensitivity of 72% and specificity of 93% 1.
- Serum lipase measurement: More reliable diagnostic marker of AP than serum amylase, with a sensitivity of 79% and specificity of 89% 1.
Important Considerations
- Non-pancreatic diseases: Lipase can be elevated in non-pancreatic diseases such as renal disease, appendicitis, acute cholecystitis, chronic pancreatitis, and bowel obstruction 1.
- Timing of blood sampling: Clearance of amylase and lipase varies depending on the timing of blood sampling, which can affect diagnosis 1.
From the Research
Causes of Hyperamylasemia
- Hyperamylasemia can result from an increased rate of entry of amylase into the circulation and/or a decreased metabolic clearance of this enzyme 2
- The pancreas and salivary glands are the primary sources of serum amylase, and conditions affecting these organs can lead to hyperamylasemia 2
- Pancreatic hyperamylasemia can result from an insult to the pancreas, such as pancreatitis, or from loss of bowel integrity 2
- Salivary-type isoamylase hyperamylasemia can occur in conditions involving the salivary glands, as well as in conditions such as chronic alcoholism, postoperative states, and malignant neoplasms that secrete amylase 2
- Decreased metabolic clearance of amylase due to renal failure or macroamylasemia can also cause hyperamylasemia 2, 3, 4, 5, 6
Macroamylasemia as a Cause of Hyperamylasemia
- Macroamylasemia is a benign condition characterized by the formation of high molecular mass complexes that can cause elevated serum amylase levels 3, 4, 5, 6
- Macroamylasemia can occur in healthy individuals, as well as in those with various diseases, including autoimmune disorders and malignant tumors 4, 5
- The presence of macroamylasemia should be suspected when clinical history and condition do not match the measured enzyme value, to avoid diagnostic errors and unnecessary invasive examinations 3