FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

ELEVATED “ALT” PROVES LIVER PROBLEM, BUT DOESN’T PINPOINT CAUSE

Question: After donating blood in October, I was notified that my ALT was high and the blood was rejected.  I have had blood tests since then, and the ALT is still high: 82, 86, 259, 144, 63, 188 and last week 62.  I haven't taken any medications since November '02 and was off all alcohol for 6 months.  An ultrasound showed no liver problems, and my liver biopsy in March was "inconclusive."  I'll continue to check blood at 3 month intervals.  All Hepatitis tests have returned negative, thank goodness.  Would you have a clue as to what might cause the enzymes to be so whacky?  I do have wine a couple of nights a week now.

Answer: It certainly sounds like you have been very vigilant in trying to track down the cause of your elevated ALT. Let me try to help you understand what might be going on.

Alanine Aminotransferase (ALT) is a liver enzyme. It used to be called SGPT, so you may see it referred to this way in some older literature. ALT is produced in the cells of the liver and is commonly elevated when liver cells are inflamed or die. Damaged or inflamed cells break open and leak ALT into the bloodstream. The ALT is a very sensitive and very specific laboratory indicator for damage to the cells of the liver.

In many liver conditions, an isolated elevation of ALT may be the only clue to underlying liver disease. Some liver enzymes can be elevated because the liver reacts to a biochemical imbalance produced by a disease in another organ. This is not the case, however, with ALT. It is very specific for liver problems. This means that when ALT is elevated, your doctor knows that the problem is actually in the liver rather than another organ.

Many viral infections, like hepatitis, cause ALT to be elevated. The blood tests and the liver biopsy can rule these out, but sometimes are inconclusive early in a chronic disease like Hepatitis C. It is possible, therefore, that you have hepatitis but it hasn’t manifested itself to the point that it’s detectable by the tests. In addition to hepatitis, other viral diseases that can cause damage to the liver -- like infectious mononucleosis, cytomegalovirus and herpes simplex -- can also elevate the ALT.

Many medications, like Tylenol, antibiotics, high blood pressure medications, Ibuprofen and cholesterol medications can elevate the ALT because these medications are metabolized in the liver. Alcohol, as you mentioned, is also a major cause of liver problems and increased ALT.

There are still a number of other things that can cause ALT to become elevated. These include systemic illnesses such as hyperthyroidism that has been present for awhile, as well as a type of hepatitis that’s caused by an autoimmune reaction in your body. Also, the common American malady of obesity can increase the ALT level. This obesity-ALT link has even been noted in obese children.

It sounds as though your evaluation to date has been very thorough, but continued testing is in order, as the ALT is never elevated for no reason at all. Even if your ALT returns to normal, I recommend that you continue to have it checked on a regular basis to make sure that it does not become elevated again.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.