BMJ 1996;313:1265 (16 November)

Letters

Pancreatitis may occur with a normal amylase concentration in hypertriglyceridaemia

EDITOR,--Johan Hedstrom and colleagues report that the trypsin 2-(alpha)1 antitrypsin complex is a diagnostic marker of pancreatitis.1 This reminds us of a diagnostic problem that arose when only the serum amylase concentration was considered in a patient with severe abdominal pain.

A 39 year old Muslim man presented with severe generalised abdominal pain. The surgical team concluded that his amylase concentration (57 IU/l; normal 0-90 IU/l) excluded acute pancreatitis. He had non-insulin dependent diabetes, smoked 20 cigarettes a day, and rarely drank alcohol. He had bilateral supraorbital xanthelasmas and a tender but soft abdomen. Investigations showed a random blood glucose concentration of 13.3 mmol/l, total cholesterol 14.7 mmol/l, and triglycerides >53 mmol/l in a non-fasting sample. An uncuffed calcium concentration was 2.04 mmol/l and plasma albumin 34 g/l. Triglyceride concentrations were subsequently measured in fasting samples (table 1). 


Table 1--Biochemical results in patient with pancreatitis and hypertriglyceridaemia who . . . [Full text of this article]


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Relevant Article

Serum complex of trypsin 2 and (alpha)(sub 1) antitrypsin as diagnostic and prognostic marker of acute pancreatitis: clinical study in consecutive patients
Johan Hedstrom, Vesa Sainio, Esko Kemppainen, Reijo Haapiainen, Eero Kivilaakso, Tom Schroder, Jari Leinonen, and Ulf-Hakan Stenman
BMJ 1996 313: 333-337. [Abstract] [Full Text]

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