Elevated amylase, last CT scan of pelvis/abdomen normal

[LPFnyc]

In August 2008, my wife, who is 48, was diagnosed with GERD and put on Prevacid. The GERD was fairly severe, but the Prevacid helped her greatly along with a modified low fat diet.

In November of 2008, during her routine physical, her blood work showed an amylase level of 108. Since this had never happened before, her primary care physician ordered a barium contrast CT scan of her abdomen and pelvis. The results were normal.

During her routine physical this year, her amylase level was 145. Her primary care physician ordered another blood test, but this time to break the amylase into pancreatic and salive. The results were Amylase 78, Salivary Amylase 57, Total Amylase 135.

I should say here that all her other blood work was normal. Her GERD is pretty much gone, and she's been off of the Prevacid since the middle of this year. She is managing it with Tums and the occassional Zantac.

Her primary care physician thought my elevated amylase might be due to macroamylasemia. But wants her to see a pancreatic specialist, which we'll be doing in a few weeks.

My question is why doesn't her PCP just want to leave it as macroamylasemia?

She's a bit concerned about this and any feedback would be welcome

[Bosco]

Dear Dr. Kini,

Like the person who wrote previously, I have elevated amylase. I am 51, mildly diabetic and take Avandamet twice daily. I am female and in menopause. About 2 months ago my blood tests showed amylase of 181. I was sent for an abdominal sonnogram and pancreatic MRI, both of which were fine.

Now, two months later I was retested and my levels are higher, at 200. My dr is now sending me for a transvaginal sonnogram as well as to a gastroentinologist for a consult.

After scouring the internet, I am now terrified that the underlying cause might be ovarian cancer? There are references to this throughout many medical sites, but most sites connect amylase to pancreatic problems or gallstones, neither of which seems to be the issue.

I will say though, when this first came to light I was not being as careful as I should about my carb and sugar intake, and had spent one evening quite sick to my stomach with the kind of pain associated w/ pancreatis. I was better by morning though, and dismissed the incident and began to clean up my diet as well  (few carbs, low sugar and no gluten).

Any thoughts would be very much appreciated.
Thank you.

[Ratnakar Kini]

Hi,
I dont know what is the reference range for serum amylase in the laboratory that you have done the test.
The normal value is usually upto 85U/L. Only when it rises more than 2-3 times the upper limit of normal, it is considered due to pancreas disease. The increased amylase levels due to pancreatic disease returns to normal level within 3-5 days.

There are umpteen number of causes or raised amylase levels one of which is macroamylasemia. The most important feature of this condition is that urine amylase will be absent.
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The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.

[JPost]

A related discussion, High Level Liver Enzymes combined with Low Amylase levels was started.

[LPFnyc]

Dr. Kini,

Once again, thanks for your answer on this.

We will see what the pancreatic specialist, to whom her PCP referred her, wants to do.

You have been a GREAT help!

[Ratnakar Kini]

Hi,
If up to 0-100U/L is given as normal range, then your wife's amylase value is less than 2-3 times the upper limit of normal which rules out pancreatic disease. As I said earlier even if it is due to pancreatic problem it will return to normal level within 3-5 days ( which is not in your wife's case)

Persistently high levels of amylase is commonly due to macroamylasemia and an urine test would be helpful as said earlier.
================================================================
The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.

[LPFnyc]

Dr. Kini,

Thanks for your response!

I do recall reading that amylase value can be based on U/L, though I do know there are other standards. What standard my wife's PCP used for her blood test, I do not know.

However, I do know that her PCP said a normal combined amylase level for this test was anywhere from 0-100, if thet helps in your evaluation.

Thank you for the information on the urine amylase. The interesting thing is that her last physical, October of this year, she did not take a urine sample.

Based on the information I have given above, would you be able to guess, and I know it would be just that, as to the reason for this raised level? They have been raised since November 2007.

By the way, her PCP is not concerend with these numbers. He just wants to know why it's happening. It is for this reason that he did not order another CT scan (She had one a year ago.) but referred her to a pancreas specialist.

Again, any insight would be greatly appreciated!