Pancreatic disorders, both inflammatory and neoplastic, are increasingly occurring in industrialized countries. Acute pancreatitis is a sudden inflammation of the pancreas that is caused by choledocholithiasis, alcohol abuse or in rare cases due to pancreatic cancer, hyperlipidemia, hypercalcemia, mumps or aids. Chronic pancreatitis is a long-lasting inflammation of the pancreas. Due to recurrent inflammation episodes, the pancreas loses its original structure and then its function.
Clinical chemistry tests for α -amylase, pancreatic amylase and lipase are used in detection and follow-up of pancreatitis and diagnosis of abdominal disorders.
Amylase in serum consists of two isoenzymes: Salivary amylase originating from the salivary glands and pancreatic amylase produced by the pancreas. While the specificity of α-amylase is not very high for pancreatic disorders, as elevated levels are measured also in various non-pancreatic diseases, e.g. parotitis and renal insufficiency, pancreatic amylase is specific for pancreatic disorders.
Although the pancreatic amylase is much more specific for detection of pancreatic disorders than the total amylase, for confirmation of an acute pancreatitis an additional measurement of lipase is recommended. Lipases are enzymes which hydrolyze glycerol esters of long fatty acids. The enzyme and its cofactor colipase are produced in the pancreas. Due to its long half-life, lipase values are elevated longer after a pancreatitis than those of α- and pancreatic amylase.
The combination of both, lipase and pancreatic amylase, highly increases the sensitivity for the detection of pancreatitis.
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α-Amylase CC FS
Pancreatic amylase CC FS
Lipase DC FS
References:
1. Thomas L, editor. Clinical laboratory diagnostics. 1st ed. Frankfurt: TH-Books Verlagsgesellschaft; 1998. p.192–202.
2. Moss DW, Henderson AR. Digestive enzymes of pancreatic origin. In: Burtis CA, Ashwood ER, editors. Tietz Textbook of Clinical Chemistry. 3rd ed. Philadelphia: W.B Saunders Company; 1999. p.689-98.
Isabella Wieland