The present status of the serum lipase test

Summary

• 1. Selected data were presented from a series of 1200 serum lipase determinations on 800 patients.

• 2. The behavior of serial serum lipase determinations was analyzed in a selected group of 5 cases of acute pancreatitis, one case of chronic pancreatitis and 3 cases of malignancy of the pancreas.

• 3. Analysis of our cases of acute pancreatitis suggests that the decrease in serum lipase concentration following an initial elevated serum lipase, may be due either to a subsiding of the inflammatory process or to complete destruction of the pancreas. There was 21 cases of acute pancreatitis, in 17 of which (81%) the serum lipase was elevated.

• 4. The serum lipase curve in one case of chronic pancreatitis was indistinguishable from that of pancreatic malignancy.

• 5. The serum lipase curves in cases of pancreatic malignancy suggest that the initial elevation of the concentration of serum lipase is due to an obstruction to the free flow of pancreatic juice. The subsequent decrease in the concentration of the serum lipase is due either to replacement of pancreatic tissue by the malignant process or to impaired pancreatic function secondary to prolonged pancreatic duct obstruction. There were 30 cases of malignancy of the pancreas, in 16 of which (53.3%) the serum lipase was elevated.

• 6. Certain limitations of the serum lipase determination are discussed with reference to the variability of the olive oil substrate.