Long-standing pancreatic hyperenzymemia: is it a nonpathological condition?

Chronic nonpathological pancreatic hyperenzymemia is characterized by a chronic, abnormal increase in the serum concentrations of the pancreatic enzymes including amylase, pancreatic isoamylase, lipase and trypsin. The diagnostic work-up that the physicians should recommend to subjects with hyperenzymemia to definitively assess this syndrome is still an open question. A 72-year-old female was admitted to our Pancreas Unit in December 2008 for the presence of long-standing pancreatic hyperenzymemia of 42 years duration. On admission, serum amylase activity was 160 IU/l (reference range 8-78 IU/l), serum pancreatic isoamylase activity was 91 IU/l (reference range 13-53 IU/l) and serum lipase activity was 127 IU/l (reference range 8-78 IU/l). Other laboratory examinations revealed normal blood tests except for total serum cholesterol, HDL cholesterol and serum triglycerides that was slight elevated. Abdominal ultrasonography demonstrated no alteration of the pancreatic gland. A magnetic resonance cholangiopancreatography was carried out according to our diagnostic work-up of patients with unexplained pancreatic hyperenzymemia. This examination revealed two small cystic lesions: one of 6 mm in diameter in the head of the pancreas and the other one of 9 mm in diameter in the body of the pancreatic gland. The duct of Wirsung was normal and the two cystic lesions were diagnosed as branch-type intrapapillary mucinous tumors of the pancreas. All patients with pancreatic hyperenzymemia should be strictly followed in high volume centers for pancreatic disease in order to early diagnose the possible appearance of morphological pancreatic alterations