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Very High Liver Enzymes - 27 year old male

I am a 27 year old male.  Don’t smoke, rarely drink.  Never used IV drugs, never had a blood transfusion never been hospitalized.

Recently, had a physical for life insurance and my ALT = 590 & AST =250.  All other tests were normal.  The physical was on April 15th, and I received the information on May 15th.  That day, I went to an urgent care clinic & had blood work for liver panel, hep panel, ANA, CBC, and lipids.  At the urgent care clinic they scheduled an abdomen ultrasound.

5/21: I had my ultrasound and received my blood work from the urgent care clinic.  The ultrasound came back fine - normal, healthy liver, kidney & gallbladder.  No stones or tumors.  The blood work from 5/15 showed an ALT of 1600, an AST of 600, CK of approximately 450, and my bilirubin was 1.8.  I tested negative for hep A, B, C & my ANA was negative.

5/22: Appt family practitioner.  She referred me to a specialist.  She did a liver panel test again.  My ALT came back at 900 with my ALT at 290, bilirubin was perfectly normal.

5/23 Appt with liver specialist.  He ordered more blood tests; testing for epstein-barr virus, cyclomegavirus, iron & ferritin (hemochromatosis), hep A-B-C again, and numerous other tests.
I have no major symptoms - no nausea, jaundice or diarrhea.  I don't use drugs, haven't taken any Tylenol.  Note that I am a world-class weightlifter.  My best squat, bench and deadlift is 840lb, 580lb, and 683lb.  I had been working out heavy as usual up until May 15th, now taking it easy.  I should also note that I have never taken steroids - I lift in a drug-tested federation.

Also on 2/5 I had a sore throat, tonsillitis and fever that was confirmed not to be strep.  This sore throat w/ ulcers lasted for 6-8 weeks.

I haven't had any blood test results in the years past from prior physicals, etc., have anything elevated.

Please advise.  I am scared, recently a new father and afraid I won’t be on this earth for my daughter & wife.
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4610897 tn?1393869202
Thank you for your question.
The question you ask if a very common scenario. In fact, I recently answered a question of a person who asked about this same problem:

Before I begin I would like to congratulate you on your accomplishments in powerlifting. I enjoy powerlifting as part of Crossfit and your 1 rep maxes are simply incredible!

The link I cited above should give you the general idea of approach to elevated liver enzymes. So far it sounds like you have had all the appropriate tests ordered and are in the right hands.

A few tests you didn’t mention include: SPEP, serum protein electrophoresis; SMA, smooth muscle antibodies; Ceruloplasmin (a test for copper deposition disease also known as Wilson’s disease); HCV RNA (hepatitis C viral load testing, different than antibody testing); α1-AT phenotype, α1-antitrypsin; TFTs, thyroid function tests; TTG antibody tissue transglutaminase (test for celiac disease).

If all of these tests are unrevealing, the next test is a liver biopsy. Although it is invasive it is an invasive procedure it will probably be your best chance of yielding a diagnosis to give you closure on this matter. However, this test is often undertaken with the acknowledgement that the results of the biopsy are unlikely to alter management.

However, I recommend you discuss this with your gastroenterologist.

Thank you for your question!

Dr. S
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