Two rare cases of benign hyperlipasemia in children

Table 1 Principal causes for increased serum levels of pancreatic enzymes

Causes	Suggested work-up
Pancreatic diseases Drugs Infections Tumors Autoimmunity Trauma Anatomic anomalies Gene mutation Cystic fibrosis Viral hepatitis Surgery	Full blood count, erythrocyte sedimentation rate, PCR, immunoglobulin Liver function tests Fecal elastase Serum trypsinogen IgG4 Cytomegalovirus serology and cultures, ebstein-barr, toxoplasma, rubella, parvo and herpes virus serology Sweat analysis Genetic analysis (CFTR, PRSS1, SPINK1) US CT scan
Biliary diseases Biliary lithiasis Anatomic anomalies Tumors Sphincter Oddi dysfunction	Full blood count, erythrocyte sedimentation rate, PCR, immunoglobulin US scan Cholangio-pancreatographic MRI
Macroenzymemia Celiac disease Inflammatory bowel disease Autoimmune diseases Liver diseases Lymphoma Thyroid cancer	Full blood count, erythrocyte sedimentation rate, PCR, immunoglobulin Liver function tests Autoimmune profile: anti-transglutaminase, perinuclear, antineutrophil cytoplasm and anti-saccharomyces cerevisiae, and islet cell antibodies US scan
Renal diseases Inflammatory Neoplastic Impaired renal function	Full blood count, erythrocyte sedimentation rate, PCR, immunoglobulin Renal function tests US scan
Others Peptic ulcer Paravaterian diverticulum Intestinal obstruction Dyslipidemia Diabetic ketoacidosis Malignancy	Full blood count, erythrocyte sedimentation rate, PCR, serum glucose Serum cholesterol and triglycerides US scan EGDS

US: Ultrasound; CT: Computed tomography; CFTR: Cystic fibrosis transmembrane conductance regulator; MRI: Magnetic resonance imaging; EGDS: Esophagogastroduodenal endoscopy; PCR: Polymerase chain reaction.