[Unexplained, subclinical chronically elevated transaminases].

Area of Science:

• Hepatology
• Clinical Biochemistry
• Internal Medicine

Background:

• Elevated transaminases (liver enzymes) are common biochemical findings.
• Often associated with metabolic syndrome, non-alcoholic fatty liver disease, alcoholism, and diabetes.
• Viral hepatitis and iatrogenic causes also require consideration.

Purpose of the Study:

• To outline a diagnostic approach for unexplained, subclinical chronically elevated transaminases.
• To highlight less common causes, including muscular disorders and rare genetic conditions.
• To guide the appropriate use of liver biopsy.

Main Methods:

• Review of clinical presentation and diagnostic workup for hypertransaminasemia.
• Emphasis on patient history, physical examination, and targeted laboratory testing.
• Consideration of creatine phosphokinase for muscular disease evaluation.

Main Results:

• Hypertransaminasemia can be an early marker for various conditions, from common metabolic disorders to rare genetic diseases.
• Muscular diseases, especially in pediatric patients, should be considered.
• Specific conditions include hemochromatosis, celiac disease, autoimmune hepatitis, Wilson's disease, alpha-1-antitrypsin deficiency, and endocrine disorders.

Conclusions:

• A systematic diagnostic approach is crucial for unexplained elevated transaminases.
• Liver biopsy is reserved for specific cases after initial investigations and dietary interventions.
• Early identification of underlying causes is key to effective management.