GILBERT'S SYNDROME - A CONCEALED ADVERSITY FOR PHYSICIANS AND SURGEONS

Area of Science:

• Hepatology
• Clinical Biochemistry
• Genetics

Background:

• Gilbert's syndrome (GS) is the most common hereditary cause of mild unconjugated hyperbilirubinemia.
• While clinical and pharmacological effects are documented, its significance as a clinical precaution for physicians and surgeons is not clearly established.

Purpose of the Study:

• To systematically review the literature on Gilbert's syndrome.
• To establish the clinical importance of GS as a precautionary sign for medical and surgical professionals.

Main Methods:

• A systematic literature search was conducted using PubMed with keywords: Gilbert's syndrome, hyperbilirubinemia, clinical and pharmacological aspects.
• 375 articles from the last 40 years were initially retrieved; abstracts were studied.
• 40 articles and 2 case reports were thoroughly reviewed based on relevance.

Main Results:

• Mild hyperbilirubinemia in GS can be mistaken for serious liver conditions.
• GS is linked to impaired drug detoxification, spherocytosis, cholelithiasis, hemolytic anemia, and intra-operative toxicity.
• Specific drug toxicities (irinotecan) and metabolic issues (morphine) are associated with GS.

Conclusions:

• Gilbert's syndrome possesses significant clinical importance, often leading to misdiagnosis.
• Accurate diagnosis of GS is crucial to prevent overlooking associated adversities and drug-related complications.
• GS has profound phenotypic effects and can cause abnormally high bilirubin levels under certain conditions.