Varying scenarios:
(1) macroamylase alone with normal pancreas and normal serum lipase
(2) macroamylase in a patient with pancreatitis
(3) concurrent macroamylasemia and macrolipasemia
(4) no macroamylase
Clues to macroamylasemia:
(1) elevated serum amylase activity without clinical findings to explain the finding
(2) normal serum lipase
(3) normal urine amylase (with ratio amylase to creatinine) in a patient with normal renal function
(4) elevated serum amylase activity and negative workup
(5) elevated serum amylase activity in a patient with an autoimmune disorder
If the diagnosis is suspected then additional testing can be performed:
(1) separate the normal from macro-amylase by chromatography (HPLC, gel filtration, other)
(2) polyethylene glycol (PEG) test, which precipitates out the macroamylase. After treatment the serum amylase activity is much less than it was before.
