Macroamylasemia Symptoms, Causes, Diagnosis, Treatment

Macroamylasemia Symptoms, Causes, Diagnosis, Treatment

Macroamylasemia is a disease defined by an elevation in serum amylase activity due to the presence of complex macromolecules whose huge size inhibits their elimination via the urinary system.

It is not possible to correlate it in any reliable way with any specific illness condition, and therefore, it ought to be treated as a harmless chemical aberration. Immunoglobulin binds to amylase in macroamylasemia, making it bigger than regular and preventing it from being processed by the kidneys, leading to high serum amylase concentrations but average urine values.

Molecular complexes that are too big to excrete in the urine are known as macroamylase. Consequently, its existence is represented by an increase in serum amylase activity. Macroamylase results from the immunoglobulin-amylase complex or the polymerization of regular amylase and polysaccharide.

Macroamylasemia Symptoms, Causes, Diagnosis, Treatment


Macroamylasemia Symptoms

In most cases, macroamylasemia is defined as a high blood amylase level without clinical illness. However, this disorder must be appropriately diagnosed when symptoms are present, particularly those with an abdominal origin, to prevent needless treatments for other associated diseases.

In laboratory tests, macroenzymes are not unusual. Several proteins, such as globulins and carrier molecules that make up blood, self-polymerize or form a compound with other proteins. Macromoamylasemia causes the amylase molecule to combine with globulin to produce an amyloid-like macromolecule of about 200kDa, while the typical amylase is 45kDa. Although the majority is recirculated in the tubules, around 25% of normal, non-complexed amylase is readily processed at the renal glomerulus. 

A continuous, severe upper abdominal discomfort spreading to the back and an increased blood amylase level is the classic symptoms of this acute disease. Vomiting and nausea are frequently present. These symptoms also include very dry mouth, frequent urination, intense tiredness (fatigue), and a reduction in body weight. Usually, this is just transitory.

Macroamylasemia Causes

It is also not unusual to encounter hyperamylasemia in association with other autoimmune disorders or diseases, which indicates macroamylasemia rather than pancreatitis or other hyperamylasemia-related conditions. Because of this, the levels of amylase and lipase can become as much as three times higher than the typical upper limit. Some other common causes of macroamylasemia are:

  1. Cholecystitis can make amylase levels rise, which can lead to hyperamylasemia and eventually Macroamylasemia.  
  2. Hyperamylasemia is also caused by kidney failure.
  3. Cholangiopancreatography (ERCP) operation also induces Hyperamylasemia, which may result in Macroamylasemia.
  4. Extreme weight gain (obese).
  5. Excessive blood triglyceride levels.
  6. Excessive use of alcohol.
  7.  Gall bladder stones. 
  8. Pancreatitis.
  9. Liver disease.
  10. Diabetes. 
  11. Cancer. 
  12. Malabsorption. 
  13. Autoimmune diseases. 
  14. Intravenous hydroxyethyl starch.

Macroamylasemia Diagnosis

An acceptable strategy for validating a diagnosis of this disease is to examine the serum lipase, which with increased amylase values usually indicates pancreatitis. Renal function must be assessed if serum lipase levels are normal because improper kidney function would also result in higher levels. 

Renal amylase clearance proportional to creatinine level is determined when normal kidney function is established; normal proportions are between 3 and 5 percent, and a result of less than 1 percent shows macroamylasemia. Electrophoresis, poly-ethylene glycol precipitation testing, and chromatography are the final confirmatory tests for macroamylasemia.

Diagnosing the pancreatic origin of amylase is critical when dealing with hyperamylasemia and the potential for macroamylasemia. Since pancreatitis is linked to elevated serum lipase, this can be done by measuring the level of the enzyme. As blood markers of pancreatic enzymes, isoamylase and lipase measurements are similar to total amylase measurements. Often, isoamylase and lipase levels stay high even after total amylase levels have returned to normal.

Macroamylasemia Treatment

Macroamylasemia is a congenital enzyme problem that leads to hyperamylasemia, which is characterized by abnormally high amounts of amylase activity in the bloodstream. It is caused by improperly bonded amylase molecules in the bloodstream, usually IgG and/or IgA. (immunoglobulin A).

Doctors and other healthcare providers advise patients with elevated blood amylase levels to abstain from alcohol and medications while also closely monitoring their symptoms and lab results. The following care should be taken to avoid this acute condition:

  1. NSAIDs, or non-steroidal anti-inflammatory drugs.
  2. Avoiding alcohol and taking all recommended medications are the main therapies for increased blood amylase levels in outpatients without pancreatitis.
  3. Be sure to carry out every recommendation made by the healthcare provider.
  4. Follow a diet high in fiber and low in fat and red meat.

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