Isolated Gamma-Glutamyltransferase Elevation During Statin Therapy: A Diagnostic Pitfall and a Stepwise Management...

The management of patients with isolated gamma-glutamyltransferase (GGT) elevation during statin therapy remains a common clinical dilemma due to the unclear relevance to hepatotoxicity. We report a case of a patient with coronary artery disease who developed persistent isolated GGT elevation (> 100 U/L) while on atorvastatin, with normal alanine and aspartate aminotransferase levels. Critically, the elevated GGT persisted after statin withdrawal, and a comprehensive workup revealed uncontrolled cardiometabolic risk factors. We conclude that isolated GGT elevation in this context is more likely a biomarker of underlying cardiovascular risk than of statin-induced liver injury. Based on this case analysis, we propose a stepwise decision framework to guide evaluation and management in such scenarios. Through literature review and case analysis, we conclude that isolated GGT elevation is not a reliable indicator of statin hepatotoxicity and may be associated with cardiovascular risk. Therefore, clinicians should not hastily discontinue statins. Instead, a comprehensive assessment should be initiated to identify potential causes and personalize treatment.