The apparently well patient with chronically elevated aminotransferase levels is a medical challenge. A knowledge of the differential diagnosis permits rational investigation in such cases.
The causes of asymptomatic chronically elevated aminotransferase activity include:
- alcohol abuse
- drugs
- chronic hepatitis: B and C
- steatosis and non-alcoholic steatosis
- non-alcoholic fatty liver disease (NAFLD) includes a wide spectrum of liver pathology, ranging from fatty liver alone to the more severe nonalcoholic steatohepatitis (1)
- NAFLD is the most common cause of chronically elevated LFTs in the United States in both diabetic and nondiabetic individuals
- with respect to patients with NAFLD, 60-95% are obese, 28-55% have type 2 diabetes, and 20-92% have hyperlipidemia (2)
- autoimmune hepatitis
- haemochromatosis
- Wilson's disease
- alpha1-antitrypsin deficiency
Non-hepatic causes include:
- coeliac disease
- inherited and acquired muscle diseases
- exercise
Reference:
- Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346: 1221-31.
- Harris EH.Elevated Liver Function Tests in Type 2 Diabetes.Clinical Diabetes 2005; 23:115-119.