Diagnosis of macroamylasemia in a pregnant patient

Macroamylasemia occurs with the formation of macroamylase complexes that cannot be cleared via renal excretion. In patients with persistent serum amylase elevation or hyperamylasemia with normal urine amylase and lipase levels, the diagnosis of macromylasemia is suggested.

The patient is a 31-year-old G2P1 who presented to the ob/gyn triage with the complaint of recurrent right-sided abdominal pain. Serum amylase values were elevated. The patient had been admitted previously at GA 16 weeks for recurrent acute cholecystitis and gallstone pancreatitis and had undergone laparoscopic cholecystectomy.

In the absence of characteristic findings suggestive of acute cholecystitis or gallstone pancreatitis, clinicians should evaluate urinary and serum amylase isoenzymes to exclude hyperamylasemia due to elevated serum macroamylase levels. Additional interventions may not be required to assure optimal maternal or fetal outcome.