elevated liver enzymes

[bullbofa]

I have had elevated liver enymes for six years now but were never watched,so 5 years later i went to doctor because i wasn't feeling well. I found that my alkaline phosphatase was 260 and ALT 157 and AST 103 and this went on for 1 year i was later diagnosed with lupus (sle) i suffer chronic fatigue, chronic pain and my hair falls out in patches . My liver biopsy states mild congestion possibly caused by right side heart problems. The rest of the biopsy normal. I was later started on prednisone 20 mg. After 3 weeks my enzymes were lowered after 7to8 weeks they were returned to normal. I felt wonderful my hair grew back my pain was gone and i wasn't tired all the time. I Did forget to mention that my ana was positve 1:80 ana pattern homogeneneous/speckled. I was weened down slowly to 5 mg of prednisone,my liver enzymes stayed normal as i reached 5 mg for about 1 month i started not feeling good again and my enymes were up again but just a little . I went to the mayo clinic for a second opion but to find out I never had lupus and my ana was normal so now i am being weened off of the prednisone. They found that i have a gallstone so that is the pain i have had in my right side but they said that can effect the alkaline phosphatase but not the ast,alt. So they said      i most likely have a fatty liver so they requested the slides of my biopsy and had them looked over and there is no evidence of a fatty liver. Therefore they do not know what is causing this. My question to you is what could be causing these elevated liver enzymes? I your opion can 1 gallstone cause alt,ast and alkaline phosphatase to be elevated all this time? Why did the prednisone work to bring them down to normal ? And now that i am on a lower dose there are going back up? I have been checked for hepatitis a,b,c mitochondrial antibody. My ggt was 184. I have been tested for mono. Can other diseases such as heart or lung disease affect the liver? So far all blood work is normal with exception of the liver enzymes. I do not drink , no drugs and i don't even take anything for a headache or stomache cramps. Sorry this isn't in order i just write as i remember this has been a long process. The mayo clinic suggests after i get off the prednisone and when i get all aches and pains back come back and we will look everything over again but for now lets just figure out what's going on with the liver. They said if it is a autoimmune process that would  have shown on the biopsy. So i am confused and so it seems so is everyone else. Please give me your opion on this situation. Thank you.

[Kevin Pho, MD]

Hello - thanks for asking your question.

It appears you have been evaluated thoroughly with a liver biopsy and physicians at the Mayo Clinic.  I will give information on elevated liver enzymes, but please understand that I cannot diagnose you over the internet.  

There are many reasons that can cause elevated liver enzymes.

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

Alcohol abuse - In a study of hundreds of patients who had liver biopsy confirmed liver disorders, more than 90 percent of the patients whose AST to ALT ratio was two or greater had alcoholic liver disease.

Hepatitis

Hereditary hemochromatosis — Hereditary hemochromatosis (HHC) is a common genetic disorder. Population screening has shown that the frequency of heterozygotes is about 10 percent in Caucasian populations in the United States and western Europe, with a frequency of about 5 per 1000 (0.5 percent) for the homozygous state.

Hepatic steatosis and steatohepatitis — Hepatic steatosis and an associated condition, non-alcoholic steatohepatitis (NASH), may present solely with mild elevations of the serum aminotransferases, which are usually less than fourfold elevated.

Muscle disorders — Elevated serum aminotransferases, especially AST, may be caused by disorders that affect organs other than the liver, most commonly striated muscle.

Thyroid disorders — Thyroid disorders can produce elevated aminotransferases by unclear mechanisms.

Celiac disease — Several reports have described elevated serum aminotransferases in patients with undiagnosed celiac disease.

Adrenal insufficiency — Aminotransferase elevation (1.5 to 3 times the upper limit of normal) has been described in patients with adrenal insufficiency (due to Addison's disease or secondary causes), including those without obvious clinical features of the disorder.

Autoimmune hepatitis — Autoimmune hepatitis (AIH) is a condition found primarily in young to middle-aged women. The diagnosis is based upon the presence of elevated serum aminotransferases, the absence of other causes of chronic hepatitis, and features (serological and pathological) suggestive of AIH.

Wilson's disease — Wilson's disease, a genetic disorder of biliary copper excretion, may cause elevated aminotransferases in asymptomatic patients.

Alpha-1-antitrypsin deficiency — Alpha-1-antitrypsin deficiency is an uncommon cause of chronic liver disease in adults.

As you can see there are several non-liver disease that can cause elevated liver enzymes as well.  These are some possibilities you may want to present to your personal physician for further evaluation.

I strongly suggest followup with your personal gastroenterologist.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.