Abnormal Liver Values - Non Symptomatic

[Gabriel1968]

Hello,
I'm a male 35 years old, 5' 6, and 145lb, polish and mid-east ancestors.
During 1999 I've been tested for a regular routine check up and found abnormal Bilirubin, TGO, TGP and GGT.
I followed the liver enzymes since then and normal values ranges as 1.5 and 2  times max values for both TGO and TGP, with many times TGO in normal ranges.  GGT ranges as well between 1.5 and 6 times over normal.

Usually bilirrubin ranges between 1.5 and 3 but never experienced jaundice even with values of 3

After been tested for major indicators last lab results were as follows

: GGT:  114 now
: TGO:  117 now
: TGP:  205 now
: Albumin: 4.9 now
: Bilirubin: direct 0.43 indirect 2.57
: Alkaline Phosphatase: 140
: Antimitochondrial Antibodies:  Non-reactive
: ANA Antibodies: Negative
: Alpha-1 Antitrypsin: 178 mg/dL
: Hepatitis Panel (chonic): Non-Reactive
: HCV - PCR-Q  <200  copies /ml
: HBV - PCR-Q  <200  copies /ml
: Serum Copper: 78 mcg/dl
: Ceruloplasmine: 35 md/dl
: Colinesterasa: 142 mU/ml
: Hemochromatosis test for genes His63 Asp and Cys282T were normal


After following the values and with periods of non alcohol at all (never been a alcohol abuser or daily drinker) or even taken an aspirine values did'nt decreased.

A biopsy was performerd to my liver and results were negative, and non inflamatory event was described.

My doctor described the case as Gilbert's Syndrome, but at the moment there is no explanation of such higher values, for TGO, TGP, GGT and Alkaline Phosphatase.
I have 8 fillings of amalgame and i read that an intoxication due to the normal scrub of the teeth might lead to an mercury intoxication that could be responsible for such higher values without symptoms.

if it's worth to mention, due to the reason that the hepatitis markers where all negative, (IgM / IgG / HBs Ag / Anti-HBc IgM / Anti-HBc IgG / Anti-HBs / Anti-HCV)  and tht I'm living in Mexico I took the vaccine for hepatitis A and B (TwinRix) 5 and 4 months ago as 1st and 2nd dose repectively.

About the Hemochromatosis test lab result do not rule out the posibilitie because only the two major mutations were tested and some hemochormatosis cases  (< 5% caucasians) are caused by defective genes so far unknown.
However, Ferritine during August 2001 was tested 117 ng/ml and during   1999 serum ferritine was 269 and ferritin saturation 51%.

Could you give some advice in how to lead further investigation to find out despite Gilbert's Syndrmome such higher values in liver enzymes?

Could be possible to have hemochromatosis? Ferritin saturation reaching the limits could be an early stage of the disease?

thanks

[Kevin Pho, MD]

You have had pretty much every test available to test your liver.  With a negative liver biopsy, it would be unlikely that hemochromatosis is present.

If you want further evaluation, you may want to test for other genotypes - such as the C282Y/C282Y HFE genotype.  Make sure that the biopsy was with quantitative iron determination which would help identify any iron overload syndrome.  

If these tests are negative, I would consider a referral to an academic medical center to further evaluate your condition.  Gilbert's Syndrome typically has normal ALT/AST (TGO/TGP).  

If not already done, I would also consider imaging the liver with an ultrasound to evaluate for fatty liver or masses.

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.

[pawla58]

A related discussion, ALT LEVEL IS HIGH was started.