Mild elevations in ALT

[osiag]

I’m 37 otherwise healthy male. Been getting a full blood work up w/ UA every 6 -12 mos for the last 7 yrs routinely. On 3 occasions, ALT had been 41-45 while I taking or w/in a mo. of taking a prescript drug eg, antibiotics or ambien. On follow up, ALT has always returned to norm w/in 4-6 wks of stopping meds. GP wasn’t very concerned, but I saw a gastro dr. Here is a synopsis of testing over the last 4 yrs. Viral tests: I have very low to no risk factors. I’ve been vaccinated for A & B. I no longer have the surface anti-B for HBV, though. However, I’ve been tested 2X for HBV – both neg. Tested for HCV 3X – all neg. Iron test from 4 yrs ago: sat -79%, serum iron – 248 & ferritin -93. Shortly, after everything was norm. Since then, ferritin has been 65 – 135. Here are iron sats since then in order: 39, 30, 10, 14, 26, 28, & 30. Fatty liver tests: recent sonogram – norm. Routinely, my glucose is under 90, tris are under 100, total cholest 140-165. Auto-immune tests: I’ve tested negative for Abs: anti-smooth muscle cell, anti-mitochondrial, & ANA. Ceruloplas was 21 (normal – 18-36) & alpha-1-antitrypsin was 110 (normal – 93-199). UA always norm.
My very recent ALT = 44 & I’ve been no meds for 7 + wks & no alcohol for 4 wks. This is the 1st time that I cannot pin ALT to anything recent. On same test everything else is normal. Since we are doing IVF, I was just tested neg. again (it’s a law) for HBV, HCV, RPR, & HIV. Dr says it may just be that ALT fluctuates between 25 -45. Albumin = 5.2. I won’t have a biopsy. Dr says forget this all. Short of a biopsy, is there anything else?

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation already.  Most physicians won't consider a biopsy unless the liver enzymes are three times the upper limit of normal.  Your ALT is clearly below that.

That being said, I cannot think of any other testing that could evaluate the liver - short of a biopsy.  Many of the major liver diseases would have already been ruled out with the testing you have had.

You can always consider another opinion with a hepatologist.

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_b

[Rubble]

I'm not a dr, but ALT of 44 is really not that high and i think falls well within the "normal range". why do you get so much blood testing, especially for hep b, c, etc?  are you in the medical field?  also, have you drank a lot in the past (you wrote you hadn't had a drink in 4 weeks)?

[leeac]

depending on the reference range, a 44 would likely qualify as 'mildly' elevated.  it looks like you've pretty much covered some of the additional testing to rule out hep, and it looks like you've gotten the ultrasound.  some other factors that may raise ALT levels are diet, supplements, heavy exercise, or receiving numerous injections.  if you are concerned about liver tumors, the AFP (alfa fetoprotein) blood test can be used as a tumor marker, but i believe a biopsy is the only definitive way to determine the actual condition of your liver tissue.

[osiag]

leeac,
do you know which supplements?

[leeac]

here's a good article on mild elevated ALT levels, and if you get to the bottom, it lists some common agents that can contribute to elevated ALT levels.  note that vitamin a in large doses is one of the items listed.  i'm not a doctor, but it would seem logical to review this list and try to reduce any of these agents in your daily diet, wait several weeks, and then retest your liver enzymes.  if successful, you may be able to identify which of the agents (if any) are contributing to your elevated ALT levels. hope this helps.

leeac

http://www.aafp.org/afp/20050315/1105.html

[osiag]

Leeac,
Thanks for the reference.  It's an excellent article!

[Dixie_Amazon]

I also have elevated ALT (60). The link isn't working for me.