Clinical Review Lesson of the week

Hyperamylasaemia: not the usual suspects

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7521.890 (Published 13 October 2005) Cite this as: BMJ 2005;331:890
  1. Rajeev Srivastava, specialist registrar ([email protected])1,
  2. Callum Fraser, consultant biochemist1,
  3. Douglas Gentleman, consultant2,
  4. Lynne A Jamieson, specialist registrar3,
  5. Michael J Murphy, senior lecturer1
  1. 1Department of Biochemical Medicine, Ninewells Hospital, Dundee
  2. 2Centre for Brain Injury Rehabilitation, Royal Victoria Hospital, Dundee
  3. 3Department of Histopathology, Ninewells Hospital, Dundee
  1. Correspondence to: R Srivastava
  • Accepted 3 May 2005

Introduction

Interpretation of abnormally high serum amylase activity is not always straightforward. Sometimes, as here, patients are erroneously labelled as having pancreatitis despite the absence of clinical features to support this diagnosis. Such assumptions may affect the interpretation of investigations.

Case report

A 53 year old woman was admitted to hospital, initially with a dense hemiparesis and dysarthria because of a left middle cerebral infarct. At the time of admission, she was recovering from a recent myocardial infarction. She was not known to be diabetic.

About six weeks after admission she complained of several episodes of vomiting. Routine haematology and biochemistry investigations were unremarkable apart from serum amylase activity of 1730 U/l (reference interval 0-100 U/l). This result immediately prompted surgical review. The surgical senior house officer diagnosed acute pancreatitis. A few days later the surgical registrar confirmed this clinical impression, although, in the complete absence of abdominal pain, the pancreatitis was described as mild. Multiple repeated measurements of serum amylase activity confirmed a rising trend, reaching as high as 5791 U/l. Abdominal ultrasound examination did not reveal any abnormality, although the pelvic region …

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