Amylase normal, lipase elevated: Is it pancreatitis? A case series and review of the literature

Objective: This study was undertaken to identify clinical scenarios in whic h the lipase is significantly elevated (three times above the upper limit o f normal) but the amylase is normal, and to examine whether or not pancreat itis is the likely cause for this seemingly unusual constellation of labora tory results. Methods: Twenty-five patients were retrospectively identified over a 2-yr period, which fulfilled the above criteria. A thorough review of their charts was conducted. In addition, a critical review of the litera ture was performed. Results: It appears that isolated elevation of lipase i n this case series was either related to renal insufficiency (two patients) , to nonpancreatic sources of lipolytic enzymes due to malignant tumors (tw o), to acute cholecystitis (two) or esophagitis (one), to delayed blood wit hdrawal (at least five patients), to hypertriglyceridemia (two), or to subc linical pancreatitis in patients without abdominal pain (three), Conclusion s: 1. An elevated lipase should not be equated with evidence for pancreatit is if the amylase is normal. 2. A simultaneous determination of both amylas e and lipase is recommended for the evaluation of patients with abdominal p ain. (Am J Gastroenterol 1999;94:463-469. (C) 1999 by Am. Coll. of Gastroen terology).