Pancreatic Enzymes Used as Markers of Active Pancreatic Disease

Two enzymes, serum or urinary amylase and serum lipase, are often measured to
determine the presence of pancreatic disease, especially acute pancreatitis.

1. Amylase:
-Serum amylase is mainly derived from pancreas and salivary glands. Amylase is a
small molecule and is filtered by the glomeruli and excreted in urine.
Elevation of serum amylase occurs in:
• Pancreatic diseases: acute and chronic pancreatitis, pseudocyst
• Parotitis
• Intestinal diseases: perforation, ischemia, obstruction.
• Biliary tract disease
• Ectopic pregnancy
• Malignant tumors of lung or ovary
• Macroamylasemia.

2. Serum lipase:
- Serum lipase is elevated in pancreatic diseases, intestinal diseases, acute
cholecystitis, and renal failure.

-Values are normal in parotitis and in macroamylasemia.

In acute pancreatitis, serum amylase begins to rise within 3-6 hours, peaks at 24
hours, and returns to normal levels by 2-3 days.

-Urinary amylase is also high in acute pancreatitis and remains elevated for 7-10
days.

-Serum lipase starts to increase within 3-6 hours, reaches maximum at 24 hours,
and remains elevated for 8-14 days Very high levels of both serum amylase and
serum lipase (i.e. >5 times the upper limit of normal) are observed in acute
pancreatitis;

- in other intra-abdominal disorders, elevations are moderate or slight.

-It has been recommended to measure both serum amylase and serum lipase if
diagnosis of acute pancreatitis is suspected

- Amylase Elevated For : 2-3 Days

- Lipase Elevated For : 8-14 days
Binding of normal serum amylase with high molecular weight plasma proteins
(immunoglobulins) leads to the formation of macroamylase.

-Because of large size, they cannot be excreted in urine. Macroamylasemia is not

associated with any clinical features, but it must be distinguished from other causes of
elevated serum amylase.