Differential Diagnosis for Low Lipase Level

Single Most Likely Diagnosis

• Normal Variation: Lipase levels can vary widely among individuals, and a low level may simply be a normal variation, especially if the patient is asymptomatic and other pancreatic enzymes are within normal limits.

Other Likely Diagnoses

• Malnutrition: Malnutrition can lead to decreased production of pancreatic enzymes, including lipase, due to the lack of essential nutrients required for enzyme production.
• Chronic Pancreatitis: Chronic inflammation of the pancreas can lead to fibrosis and atrophy of pancreatic tissue, resulting in decreased enzyme production, including lipase.
• Pancreatic Insufficiency: Conditions that lead to pancreatic insufficiency, such as cystic fibrosis, can result in low levels of pancreatic enzymes, including lipase.

Do Not Miss Diagnoses

• Pancreatic Cancer: Although less likely, pancreatic cancer can cause a decrease in lipase levels, especially if the tumor obstructs the pancreatic duct, leading to atrophy of the pancreatic tissue.
• Hepatobiliary Disease: Certain hepatobiliary diseases, such as primary biliary cirrhosis or primary sclerosing cholangitis, can lead to decreased lipase levels due to impaired bile flow and subsequent malabsorption of fat-soluble vitamins.

Rare Diagnoses

• Shwachman-Diamond Syndrome: A rare genetic disorder characterized by exocrine pancreatic insufficiency, bone marrow dysfunction, and skeletal abnormalities, which can lead to low lipase levels.
• Johanson-Blizzard Syndrome: A rare genetic disorder that affects the development of the pancreas and can lead to pancreatic insufficiency and low lipase levels.
• Pearson Syndrome: A rare mitochondrial disorder that can cause pancreatic insufficiency and low lipase levels, among other systemic manifestations.