Endocrine Abstracts

Case: A 41 year-old-Indian woman with type 2 diabetes treated with liraglutide was admitted to the Emergency Department with abdominal pain, nausea, vomiting and bloated abdomen. She was found to have raised amylase at 706 U/l. Abdominal ultrasound and CT scan did not reveal any abnormalities in the pancreas or billary tract and the patient was discharged.

She had diabetes for 9 years duration treated with metformin, pioglitazone and liraglutide. Over 2 years the dose of GLP-1 analogue was gradually increased from 0.6 to 1.8 mg at the presentation. Previously, her serum amylase showed variable results of 1481 U/l in her first pregnancy and between 62 and 249 U/l during her second pregnancy and this was attributed to parotitis.

In view of the raised amylase result and the likelihood of pancreatitis that may be associated with GLP-1 analogue treatment, the medication was stopped and she was regularly followed- up in the Diabetes Clinic. Her amylase remained raised despite the patient having no symptoms suggestive of pancreatitis.

A number of biochemical investigations can help determine whether or not a raised serum amylase may be due to pancreatitis. In this patient a normal serum lipase excluded a pancreatic origin, and a normal urine amylase fractional excretion (0.5%) added to the suspicion that the raised amylase in the absence of symptoms was due to macroamylasaemia. This was confirmed initially by PEG precipitation in the local laboratory and subsequently gel filtration chromatography in a specialised centre.

Conclusion: This is a case of chronically raised amylase but no clinical picture of pancreatitis. Macroamylasaemia is a rare benign condition that does not require treatment. The human GLP-1 analogues have been previously implicated as a risk for pancreatitis in humans. The decision to withhold GLP-1 analogues in this patient can be re-visited in the light of this diagnosis.