Beruflich Dokumente
Kultur Dokumente
:: Medicina
SOMMARIO
Curriculum
Bibliografia
Abstract
Benign pancreatic hyperenzymemia is a new syndrome recently described by
me and characterized by an abnormal increase in serum pancreatic enzymes in
the absence of pancreatic disease. Hyperenzymemia can be sporadic or
familial, it involves all the pancreatic enzymes and is persistent, although the
values fluctuate considerably even temporarily returning to normal levels.
Recognition of this syndrome is very important as it helps to reassure subjects
with this anomaly, usually very concerned, that the syndrome is benign and
that no pancreatic diseases are present; it also helps to avoid the need to carry
out numerous examinations and sometimes also hospitalization and treatments
that are completely
useless.
Introduction
In 1986 I first saw a 46-year-old man, in excellent health, who had had abnormally high serum
pancreatic enzymes for several months. He had been admitted to my department for suspected
pancreatic disease but all the biohumoral and imaging techniques carried out, including
wirsungography, were normal. I thought that the hyperenzymemia could be the expression of a
pancreatic disease (chronic pancreatitis? tumor?) that was still not evident but which would have
emerged in the days or months that followed. Instead, no pancreatic disease ever became
apparent, the patient continued to enjoy good health in the years that followed and still does,
his
serum pancreatic enzymes are frequently high and imaging techniques show an
absolutely normal pancreas. Since then, I have seen numerous other subjects, children and
adults, with the same enzymatic anomaly, and with a normal pancreas (1, 2). In this article, I
will describe the main characteristics of this new syndrome.
Phatological pancreatichyperenzymemia
There are many forms of pancreatic hyperenzymemia and they may be pathological and nonpathological; the most frequent forms are pathological and, in particular, are caused by diseases
of the pancreas (Table 1 ).
In general, an increase in the normal serum values of pancreatic enzymes is due to the presence
of acute pancreatitis, but even chronic pancreatitis, especially during the painful attacks or when
complicated by pseudocysts, tumors and pancreatic trauma can also cause hyperenzymemia.
Pancreatic hyperenzymemia can also sometimes be encountered in other diseases, mainly cystic
fibrosis, celiac disease, intestinal infarct or perforation, renal insufficiency, kidney transplant,
hepatitis and cirrhosis of the liver, chronic intestinal inflammatory diseases, and acute pancreatic
ischemia after surgery involving the heart or the aorta, especially the thoracic aorta (3). These
forms of hyperenzymemia are usually easy to recognize and their identification can be of
considerable diagnostic help. In addition to these forms, there is also a vast group of nonpathological pancreatic hyperenzymemias (Table 1 ).
Nonpathological
hyperenzymemias
pancreatic Tab. 1
Iperenzimemie pancreatiche
Hyperamylasemia
This form of hyperenzymemia has been
well-known for many years. An increase in
:: Primo Piano
Figura 1
Figura 2
Figura3
Figure 3 shows the serum values of amylase, isoamylase and lipase in the 19 subjects at the
time of the study. It can be seen that the enzymes were higher than normal, with increases
ranging from 1.3 to 5.2 times the upper normal limit for amylase, from 1.4 to 8.6 times for
pancreatic isoamylase and from 1.6 to 18.0 times for lipase. The determination of the serum
pancreatic enzymes was repeated over the following months and years and the results were
similar, with fluctuations and transient normalizations. The members of the seven families
affected by hyperenzymemia were a mother, her two sisters and two daughters; a mother and
her two children; a father and two children; three fathers and their respective three children, and
one brother and sister. Overall, there were five children under the age of 10 years.
Figura 4
Figure 4 shows the family tree of the seven families; the carriers of the enzymatic alteration
are indicated with a star.
Figura 5
In a subsequent study (10) we found that in subjects with this form of hyperenzymemia the
of 50-60, can be the first clinical sign of a tumor of the pancreas which does not become evident
for several months.
3. In almost all cases (~95%) the serum levels of all the pancreatic enzymes are abnormally
high; sometimes (~5% of cases) there is only an increase in amylase or, even more rarely, in
only lipase.
4. The correct diagnosis of this form of hyperenzymemia is very important as it reassures the
carriers of this enzymatic abnormality, usually very concerned, that they do not have a disease
of the pancreas and it avoids often numerous tests, and sometimes hospitalisation and
treatment,
that are of no use whatsoever.
Lucio Gullo
Director of the Istituto di Medicina Interna,
Universit di Bologna, Ospedale S. Orsola
Bologna, Italy
:: Archivio
Archivio Scientifico
Archivio
Scientifico
Archivio Culturale
Archivio
Culturale
Archivio Cronologico
Archivio
Cronologico