24 YO male w/ elevated AST and ALT levels, what should I think?

[jim1618]

I have kind of a long question, so please bear with me..

I am 24, male, and am in excellent health ( I was have been competitive at the elementary - varsity collegiate level for distance running and have been active my whole life).  I have no history of genetic liver disorders, cancer, or any other problems in my family, do not have hepatitis, and do not use drugs or alchohol.  I also show no symptoms of liver damage.

2 Days ago, I had a routine liver panel prior to a prescrition for propecia.  It came back abnormal only in the level of AST and ALT, 472 and 117 repectively.  My doctor ordered another test (only 17 hours later) and I still tested high 469 and 139.

Now I am getting worried because my doctor has scheduled an ultrasound and refered me to a specialist for review at UCLA medical center.  

I have been pouring over numerous materials on the internet and, because of my abnormaly high AST/ALT ratio, have found that I am likely to have liver disease from alchohol.  I think this is impossible because I don't abuse alchohol.  So from what I can tell, the only other possabilities for this high ratio would Cerhitis or some sort of tumor?  

One other thing I noted is that AST level also monitor skeletal muscle and heart tissue damage.  I did do an extremely hard workout on 1 1/2 days before my test and my arms were still sore to the point that I couldn't sraighten them even during the second test.  I think I definetly had some damage there so I'm not sure if that would affect my AST levels...

The number of different possibilities are making my head spin...I have ultrasound in more than a week and don't want to walk around nervous that whole time...

Could you please tell me
1) Is it really possible someone my age might have serious liver problems?
2) What would you interpret the function test might mean for me specifically?
3) Is it possible this test was flawed because of the workout or other reasons?
4) Shoudn't my two liver tests have been farther apart?
5) Based on my information, what would you guess the problem to be?
6) Shoud I be concerned this could be liver cancer?

Thanks for your honest opinion,
Jim

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

1) There are several liver diseases that can occur any age.  Examples would include hemochromatosis and chronic hepatitis.  

2) It is difficult to say without further testing.  A referral to a specialist and ultrasound are reasonable next steps.  Here are some potential causes:

Medications — Almost any medication can cause an elevation of liver enzymes. Common ones include nonsteroidal anti-inflammatory drugs, antibiotics, cholesterol medications, antiepileptic drugs, and antituberculous drugs.

Alcohol abuse — The diagnosis is supported by an AST to ALT ratio of 2:1 or greater.

Hepatitis B or C

Hereditary hemochromatosis — Hereditary hemochromatosis (HHC) is a common genetic disorder.  Screening should begin with a serum iron, total iron binding capacity (TIBC), and ferritin levels.

Hepatic steatosis and steatohepatitis — Hepatic steatosis and an associated condition, non-alcoholic steatohepatitis (NASH), may present solely with mild elevations of the serum aminotransferases.

3) I wouldn't attribute it to exercise.  I would ensure that liver causes are ruled out first.

4) Not necessarily.  Different liver diseases can present with different patterns in liver transaminases.

5) I cannot say without more information.  It can be any of the diseases mentioned above.  More tests (ultrasound, hepatitis screen, possible biospy) are needed.

6) The mean age of presentation of liver cancer is between 50 and 60.  To be completely sure, imaging would have to be performed.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

Liver cancer? Almost certainly not!!!! Due to your working out? Possibly. Serious? The numbers are really not very high, and are likely to mean nothing at all. A biopsy of the liver (a needle, fairly simple) would be one way to tell, but before that it's reasonable simply to plan a re-test in a couple of weeks or longer. Could someone your age have serious liver problems? Hepatitis (inflammation, due to various things including infection, drugs, immune diseases) is possible at nearly any age, but usually the numbers are much higher, and in fact most serious conditions would have more dramatic numbers. I'd guess it will turn out to be nothing important, and in fact that a specific diagnosis may never be made. Before doing much else, I'd think a repeat of the tests over a longer interval would make sense.

[roxnsox]

Go to the website of the American Liver Foundation.  It is www.liverfoundation.org.  
   Do some research on Nonalcoholic Steatohepatitis (NASH)
  
   Good luck.

[jim1618]

Surgeon,

Thanks for your comments.  I talked to my physician about doing another panel test before I see that speacialist and she thought it was a good idea.


Roxnsox,

Interesting that after all my reading, NASH was one of the major possibilities I considered.  However, I did see some research indicating that in a study done of NASH patients, the mean of their AST/ALT ratios were less than one.  Also, the range didn't indicate any values higher than 2.6.  

I noticed you were diagnosed with NASH from earlier posts, can you tell me what your liver panel tests showed when you were being diagnosed?

Thanks!

Jim

[roxnsox]

My pre-diagnosis ALT was 67 and AST was 57.  They have returned to the normal range now.  I felt really awful for years and years.  I couldn't get my doctor to take me seriously.  Finally changed doctors and was properly diagnosed.  I did a little reaserch on the internet and found that the National Institute of Health was doing a clinical trial on this Liver disease so I went there and participated in it.  Participating in the clinical trial at NIH is completely free.  They do extensive testing.  YOu might want to look at the NIH website.  It is www.nih.gov.

[jim1618]

Thanks for your information.  It's good to hear that you are improving.  What sort of things did your doctor have you do to recover from NASH?  Were you on medication?  Are there any implications of having this disease for some one in the future?

Thanks!

Jim

[roxnsox]

Up to 10 per cent of NASH patients could progress to cirrohsis.  I have moderate fibrosis.  
   The doctors at NIH are testing a insulin sensitizing drug called Actos on patients with NASH.  People with NASH have insulin resistance.  There is a website for Actos.  It is www.actos.com.  They have a little bit of information about insulin resistance on their website.  
   I completed the 48 weeks Clinical trial on Actos.  Now I will be off the drug for 6 months to see if I have a relapse.  I go back to see the doctors in April.  The doctors think that a longer period of time on the drug actos is necessary to "cure" the disease.  They plan to have a longer clinical trial of three years to test it.  I haven't decided if I will participate in it or not.

[katramans]

After a routine physical by my internist, I was told I was "borderline liver." Grammar aside, I did not have the presence of mind to ask what that meant in terms of actual numbers. I was able to deduce that I was to have another screen in three weeks, and the AST and A-- were checked, neither of which meant anything to me.

I take Depakote to help prevent migraines, and undergo regular blood tests for that, but it seems that my neurologist and my internist are intent on protecting me from myself and my questions. Why? Well, no more, thanks to you. I will ask for the actual numbers on my "borderline liver" and puzzle it out from there. I will ask very politely, mind you. However, in the best of worlds, I would ask them both to speak to each other with this statement in mind: I would rather cope one way or another with the migraines than negatively effect the function of my one and only liver. To paraphrase Beethoven, "There have been many headaches, and there will be many more, but there is only one liver."

To close, these doctors live 100 miles apart, and each is ordering another liver panel. I can only wonder how labs might differ in their computations. Anyway, thanks for sharing your courage to find just what is going on. Funny, I was far more attentive in tracking, writing down, and asking many questions when my children had health problems. Wonder what makes me reluctant to say, "Time out. What the heck is a liver panel? Can it be repaired?"

[katramans]

After a routine physical by my internist, I was told I was "borderline liver." Grammar aside, I did not have the presence of mind to ask what that meant in terms of actual numbers. I was able to deduce that I was to have another screen in three weeks, and the AST and A-- were checked, neither of which meant anything to me.

I take Depakote to help prevent migraines, and undergo regular blood tests for that, but it seems that my neurologist and my internist are intent on protecting me from myself and my questions. Why? Well, no more, thanks to you. I will ask for the actual numbers on my "borderline liver" and puzzle it out from there. I will ask very politely, mind you. However, in the best of worlds, I would ask them both to speak to each other with this statement in mind: I would rather cope one way or another with the migraines than negatively effect the function of my one and only liver. To paraphrase Beethoven, "There have been many headaches, and there will be many more, but there is only one liver."

To close, these doctors live 100 miles apart, and each is ordering another liver panel. I can only wonder how labs might differ in their computations. Anyway, thanks for sharing your courage to find just what is going on. Funny, I was far more attentive in tracking, writing down, and asking many questions when my children had health problems. Wonder what makes me reluctant to say, "Time out. What the heck is a liver panel? Can it be repaired?"

[makenzie]

I have been diagnosed with NASH. Will it make your ast & alt nos. go up to the mid 150's?

[Central_Lakes]

A related discussion, High Liver Enzymes was started.