Differential Diagnosis for Elevated Amylase and Normal Lipase in a Patient on Zepbound

• Single most likely diagnosis:
  • Pancreatitis is less likely given the normal lipase level, but chronic pancreatitis or early acute pancreatitis could still be considered, especially if the patient has symptoms such as abdominal pain.
• Other Likely diagnoses:
  • Salivary gland pathology: Elevated amylase with normal lipase can indicate salivary gland issues, such as salivary gland inflammation or obstruction.
  • Macroamylasemia: A condition where amylase is bound to immunoglobulins, leading to elevated serum amylase levels without any pancreatic or salivary gland disease.
  • Renal insufficiency: Decreased renal function can lead to elevated amylase levels due to decreased clearance.
• Do Not Miss diagnoses:
  • Pancreatic cancer: Although less likely with normal lipase, pancreatic cancer can sometimes present with elevated amylase levels.
  • Intestinal obstruction or infarction: These conditions can lead to elevated amylase levels and are medical emergencies.
• Rare diagnoses:
  • Pregnancy: Elevated amylase can be seen in pregnancy, particularly in those with conditions like preeclampsia.
  • Certain medications: Some medications, aside from Zepbound, can cause elevated amylase levels.
  • Familial hyperamylasemia: A rare genetic condition leading to chronically elevated amylase levels without any underlying disease.