Amylase Isoenzymes

Description Differentiation of total serum amylase into pancreatic, nonpancreatic (predominantly salivary) and macro forms. Amylase isoenzymes improve diagnostic specificity by revealing or excluding pancreatic involvement, for example: Differentiation of drug-induced pancreatitis from an increase in the non-pancreatic form in an HIV patient receiving highly active anti-retroviral therapy (HAART). Identification of macroamylase in an asymptomatic patient with negative imaging and raised total amylase. Amylase is an enzyme that hydrolyses polysaccharides. It occurs in many tissues and organs, including the salivary glands, which secrete S-type amylase into the mouth, and the pancreas, which secretes P-type amylase into the intestines. Its small size (54-62 kDa) permits renal filtration, and amylase is the only enzyme normally present in urine. Macroamylase is a large complex of amylase with immunoglobulin, and is a benign cause of persistently raised serum amylase with normal urine amylase and normal serum lipase. Macroamylase is found in 1 % of patients with normal amylase and 5 % of patients with high amylase rising to 13 % of HIV positive patients. Serum lipase Urine amylase N/A High pancreatic amylase: pancreatic disease, biliary tract disease, intestinal obstruction, duodenitis, perforated peptic ulcer, gastritis, mesenteric infarction, acute appendicitis High non-pancreatic amylase: salivary gland disease, mumps, parotitis, acute alcohol abuse, septic shock, diabetic ketoacidosis, cardiac surgery, tumours, drugs, ectopic pregnancy, ruptured tubal pregnancy, salpingitis, ovarian malignancy, African ethnicity High mixed/unknown amylase: renal insufficiency, trauma, macroamylase, ruptured aortic aneurysm, peritonitis Low pancreatic amylase: chronic pancreatitis, cystic fibrosis N/A Repeat measurement inappropriate

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Version 1.0 Document agreed by: L Bailey

Date: 23/04/10