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Background: There are many factors that can cause elevated serum amylase levels, including pancreatic causes such as acute pancreatitis and chronic pancreatitis. Additionally, non-pancreatic causes, such as acute abdomen and acute parotitis, can also lead to increased serum amylase. These factors generally explain the consistency between elevated serum amylase and clinical symptoms. However, there are some special cases where patients exhibit atypical clinical symptoms but have persistently elevated serum amylase levels. Among these, macroamylasemia is an important differential diagnosis.
Methods: This is a report on a case of persistent serum amylase elevation (ranging from 217.0 to 452.1 U/L over five years) without clinical symptoms. The patient exhibited normal renal function, serum lipase levels, and tumor markers. Serial abdominal CT scans, magnetic resonance cholangiopancreatography (MRCP), and chest CT examinations revealed no significant abnormalities. The polyethylene glycol precipitation method (PEG precipitation) was employed as an adjunctive screening tool for macroamylasemia.
Results: The most recent serum amylase test result was 295.8 U/L. Using the polyethylene glycol precipitation method (PEG), the polyethylene glycol precipitation activity (%PPA) was 85.46% (%PPA > 60%), indicating interference from macromolecular proteins during the detection of serum amylase in this patient. This preliminary finding suggests the possibility of macroamylasemia. Further confirmation can be performed with gel filtration chromatography or immunofixation electrophoresis if laboratory conditions permit.
Conclusions: Macroamylasemia is often detected in serological tests due to its atypical clinical symptoms and lack of awareness, leading to common misdiagnosis, unnecessary investigations, and heightened patient anxiety during medical consultations. The polyethylene glycol precipitation method (PEG) serves as a screening tool, and definitive diagnosis can prevent unnecessary healthcare resource utilization.
DOI: 10.7754/Clin.Lab.2025.250568
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