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Makroamylasämie

Immunglobulin A — Amylase — Komplexe als seltene Ursache einer Hyperamylasämie

Macroamylasemia

Immunoglobulin A-amylase-complexes as rare cause of hyperamylasemia

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Summary

A 56 year old diabetic woman with persistent hyperamylasemia, with an extremely low renal clearance of amylase and without signs of pancreatic disease was found to have an abnormally large serum amylase. This macroamylase had a molecular size of 450,000 Daltons in gel filtration and could be dissociated at low pH values. By the use of chromatographic, electrophoretic and immuno-chemical tests, it was possible to identify the macroamylase as a complex formed by immunoglobin A (IgA kappa) along with normal pancreatic and parotic amylase.

The immunoglobulins had a high affinity for human pancreatic and salivary amylase as well as for hog pancreatic amylase. It remains unclear if the amylase binding immunoglobulins are autoantibodies.

The finding of macroamylasemia should prevent patients from being subjected to superflous investigation and meaningless treatment.

Zusammenfassung

Die Befundkonstellation von persistierender Hyperamylasämie, extrem niedriger Amylaseclearance bei intakter Nierenfunktion und fehlender klinischer Symptomatik führte zum Nachweis von Makroamylase im Serum einer 56jährigen Diabetikerin. Aufgrund chromatographischer, elektrophoretischer und immunologischer Untersuchungen konnte die Makroamylase als Komplex aus monoklonalem Immunglobulin der Klasse Ig A-Kappa und normaler Serumamylase vom Pankreas- und Parotis-Typ identifiziert werden.

Diese Enzym-Immunglobulin-Komplexe basaßen in der Ausschlußchromatographie ein MG von rund 450 000 und dissoziierten in saurem pH.

Menschliche Pankreas- und Speichelamylase wurde von den Immunglobulinen ebenso gebunden, wie Pankreasamylase vom Schwein. Ob es sich bei den amylasebindenden Immunglobulinen um Auto-Antikörper handelt, ist derzeit noch unbekannt.

Der Nachweis einer Makroamylasämie vermeidet eine unnötige Diagnostik und sinnlose therapeutische Maßnahmen.

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Authors and Affiliations

  1. Medizinische Universitätsklinik Tübingen, Abt. für Innere Medizin IV, Germany

    J. Bohner, W. Stein & J. Dilger

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  1. J. Bohner
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  2. W. Stein
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  3. J. Dilger
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Bohner, J., Stein, W. & Dilger, J. Makroamylasämie. Klin Wochenschr 58, 403–407 (1980). https://doi.org/10.1007/BF01477505

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  • DOI: https://doi.org/10.1007/BF01477505

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