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Where does serum amylase come from and where does it go?
C Pieper-Bigelow1, A Strocchi, M D Levitt
1University of Minnesota, Minneapolis.
Gastroenterology Clinics of North America
|December 1, 1990
Summary
Serum amylase levels indicate amylase entry and removal balance. Elevated amylase (hyperamylasemia) can stem from increased pancreatic or salivary gland amylase entry or reduced clearance, often linked to pancreatitis or renal failure.
Area of Science:
- Biochemistry
- Clinical Chemistry
- Gastroenterology
Background:
- Serum amylase concentration is determined by amylase entry into and removal from blood.
- The pancreas and salivary glands are primary sources of serum amylase.
- Hyperamylasemia can arise from increased amylase entry or decreased metabolic clearance.
Purpose of the Study:
- To review the causes and diagnostic implications of hyperamylasemia.
- To differentiate between pancreatic and salivary-type hyperamylasemia.
- To guide diagnostic strategies for patients with elevated serum amylase.
Main Methods:
- Review of existing literature on serum amylase.
- Discussion of isoamylase techniques for distinguishing pancreatic and salivary sources.
- Analysis of clinical conditions associated with hyperamylasemia.
Main Results:
- Pancreatic hyperamylasemia is linked to pancreatic insults or bowel integrity loss.
- Salivary hyperamylasemia occurs with salivary gland issues or in specific non-salivary conditions (e.g., alcoholism, neoplasms).
- Decreased amylase clearance due to renal failure or macroamylasemia also causes hyperamylasemia.
Conclusions:
- Markedly elevated serum amylase often indicates acute pancreatitis.
- For milder elevations, specific pancreatic enzymes (lipase, trypsin) aid diagnosis.
- Distinguishing amylase source and understanding clearance mechanisms are crucial for interpreting hyperamylasemia.