Elevated Alkaline Phosphatase and ALT plus lump in scrotum - related?

[Susanbwl]

Some background: My husband is 46 years old. 6', about 195lbs. Moderate social drinker (4 - 5 glasses of wine/week). Eats a "normal" American diet, but not health-conscious. Does enjoy sweets. Very little exercise normally but started coaching a lacrosse team 3X per week last week.

He went to his PCP 2 days ago b/c he found a lump in his scrotum - not on his testical, but a pea sized (large pea) lump.  PCP thinks it's a subcutaneous cyst, but referred to a specialist and also ran bloodwork.

Alkaline Phosphatase came back "over 200" - husband wasn't specific as to how far over 200. ALT came back at 90.  He had fasted for 12 hours before the test, but did have some wine the night before (2 glasses, approx. 14 hours before the test).  Doctor wants to re-run the tests.

Insurance physical done in April 2006 (11 months ago) showed an Alkaline Phosphatase level of 82 and and ALT level of 43. Triglycerides were high at 216; cholesterol was low at 133 (48LDL;42HDL) All other bloodwork levels were normal at that time.

What is going on?
How concerned do we need to be?
Can there be a correlation between the lump and the liver levels?
He knows that he needs to fast before repeating the bloodwork - but how long does he need to abstain from alcohol? I just don't want him to have a glass of wine the night before if it's going to impact the test results.
I am, admittedly, a wreck over this. The numbers seem SO far out of line - what should our next step be?

Thank you,

Susan

[Kevin Pho, MD]

Elevated alkaline phosphatase can come from liver or bone disease.  Running further liver tests, like a GGT, can help differentiate between the two.  

If the ALT continues to be high, or if the GGT is elevated, further liver tests should be run.  This can include a liver ultrasound, as well as blood tests to rule out hepatitis.  

If the liver tests are negative, bone disease can be considered.  The initial reasonable test would be a bone scan.  

I am not aware of a specific disease connecting the lump and liver levels.  

Abstaining from alcohol for 2-4 weeks would be reasonable to ensure this is not the cause of the elevated liver enzymes.  

These options can be discussed with your personal physician.

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.

Kevin, M.D.
kevinmd_

[Kalio1]

He needs to abstain from any alcohol until they can determine what is going on. Alcohol can make his liver enzymes be elevated, but usually not in a person only drinking 3 or 4 glasses of wine a week.
If he is not drinking at all and his enzymes remain elevated then you know it was not due to alcohol and you can look at other possible causes.
Im no doctor but I don't think the raised liver enzymes and his lump in his scrotum are related. I think it just happens more than one issue presented itself at the same time. I hope it turns out to be a simple cyst. My husband gets those now and again. They freaked us out but turns out they were nothing.
I'd have him tested for Hep A B and C, it's a simple blood test and you want to rule that out if you can. Sometimes having Hep can elevate some of the blood test results you have. Nearly half of the people that find out they have Hep C find out by suprise and they have no history indicating they were exposed so I'd rule that one out right off the bat, the doctor can add it to one of his blood work lab slips.

Try not to worry too much at this point. Hang in there.