Enzyme Biomarkers: Pancreatic Lipase

Optimal Takeaways

Lipase is a fat-digesting enzyme produced primarily in the pancreas and released into the small intestine following a fat-containing meal. Relatively small amounts are found in the blood, so an elevation in serum levels is most often due to damage or disease associated with the pancreas or decreased kidney clearance. 

Low levels in the blood may be associated with pancreatic dysfunction or metabolic disorders.

Standard Range: 13 - 60 U/L

The ODX Range: 22 - 51 U/L

Low serum lipase may be observed in pancreatic cancer (Gültepe 2016), pancreatic insufficiency, chronic pancreatitis, and metabolic disorders such as obesity, metabolic syndrome, and diabetes (Ko 2020, Oh 2017).

High serum lipase is associated with acute pancreatitis, acute cholecystitis, cholangitis, extrahepatic duct obstruction, peptic ulcer, intestinal obstruction or infarction, and kidney failure. Medications may increase lipase, including morphine, codeine, cholinergics, indomethacin, and methacholine (Pagana 2021).

Serum lipase may also be elevated in appendicitis, inflammatory bowel disease, liver failure, trauma, hypertriglyceridemia, and hypercalcemia (Ismail 2017). Non-pancreatic causes of significantly increased lipase may also include celiac disease, cirrhosis, lupus, multiple myeloma, and organ damage (Hameed 2015).

Overview

Pancreatic lipase is a potent fat-digesting enzyme that breaks triglycerides down into fatty acids in the GI tract. It is produced in the pancreas and can become elevated up to 5-10 times the upper limit of normal during acute pancreatitis. Lipase remains elevated in the blood longer than amylase does and may be more useful later in the course of acute pancreatitis but less useful in chronic pancreatic disease (Pagana 2021).

Pancreatitis may be caused by hypercalcemia 10.4 mg/dL (2.6 mmol/L) or hypertriglyceridemia of 885 mg/dL (10 mmol/L) and can be accompanied by an elevated lipase at least 3 times normal. Non-pancreatic causes of elevated lipase may also elevate lipase but not to the degree that pancreatitis does (Ismail 2017).

Significantly lower serum lipase is observed in metabolic disorders, including obesity, metabolic syndrome, and type 1 and 2 diabetes (Ko 2020). Serum lipase below 20 U/L may indicate chronic pancreatitis (Oh 2017).

A low level of lipase, especially 5.5 U/L or lower, may be associated with reduced pancreatic function and pancreatic cancer. Low levels should be explored further (Gültepe 2016).

References

Gültepe, İlhami et al. “Low lipase levels as an independent marker of pancreatic cancer: a frequently neglected condition in clinical setting.” The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology vol. 27,2 (2016): 197-200. doi:10.5152/tjg.2016.16056

Hameed, Ahmer M et al. “Significant elevations of serum lipase not caused by pancreatitis: a systematic review.” HPB : the official journal of the International Hepato Pancreato Biliary Association vol. 17,2 (2015): 99-112. doi:10.1111/hpb.12277

Ismail, Ola Z, and Vipin Bhayana. “Lipase or amylase for the diagnosis of acute pancreatitis?.” Clinical biochemistry vol. 50,18 (2017): 1275-1280. doi:10.1016/j.clinbiochem.2017.07.003

Ko, Juyeon et al. “Low serum amylase, lipase, and trypsin as biomarkers of metabolic disorders: A systematic review and meta-analysis.” Diabetes research and clinical practice vol. 159 (2020): 107974. doi:10.1016/j.diabres.2019.107974

Oh, Hyoung-Chul et al. “Low Serum Pancreatic Amylase and Lipase Values Are Simple and Useful Predictors to Diagnose Chronic Pancreatitis.” Gut and liver vol. 11,6 (2017): 878-883. doi:10.5009/gnl17066

Pagana, Kathleen Deska, et al. Mosby's Diagnostic and Laboratory Test Reference. 15th ed., Mosby, 2021.