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Causes of elevated pancreatic amylase in blood and urine
Last reviewed: 06.07.2025
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Reference values (norm) of pancreatic alpha-amylase activity: in blood serum - 30-55% of total amylase (on average 43%) or 17-115 IU/l; in urine - 60-70% of total amylase (on average 65%).
In the blood serum, up to 3 isoenzymes of alpha amylase are detected, the main ones being beta and S types, i.e. pancreatic and from the salivary glands. Pancreatic amylase is better excreted in urine than the isoenzyme of the salivary glands. An increase in the activity of salivary amylase is noted in stomatitis, parkinsonism, a decrease - in mental excitement or depression, in an anacid state of gastric secretion.
The main value of determining the beta-type of alpha amylase is that an increase in its activity is highly specific for pancreatic diseases. Pancreatic alpha amylase increases in acute pancreatitis. The activity of total amylase in this case is increased due to the pancreatic fraction. The diagnostic sensitivity of the pancreatic fraction of amylase in the blood serum for acute pancreatitis is 92%, specificity is 85%.
Determination of the activity of the pancreatic fraction of alpha amylase is especially important in chronic pancreatitis in patients with a normal level of total amylase. In patients with chronic pancreatitis, pancreatic amylase makes up 75-80% of the total amylase in the blood. An increase in pancreatic amylase indicates an exacerbation of chronic pancreatitis, and a decrease indicates exocrine pancreatic insufficiency with atrophy of acinar tissue and fibrosis of the organ in patients who have suffered from this disease for a long time.
The activity of pancreatic alpha amylase, in addition to diagnosing acute pancreatitis, is also determined after surgery on abdominal organs for the purpose of early diagnosis of the development of complications - postoperative pancreatitis. Pancreatic alpha amylase in urine increases in acute pancreatitis, and makes up the bulk of total amylase, since it is excreted in urine better than the salivary fraction.
The activity of the pancreatic fraction of alpha amylase, unlike the total one, does not increase in mumps, diabetic ketoacidosis, lung cancer, acute gynecological diseases. At the same time, the test may be false positive in other diseases that do not affect the pancreas.
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