[Skip to Content]

Quiz

Rheumatology

Elevated Serum Aminotransferases

Educational Objective
To understand how to interpret the results of diagnostic tests and apply them clinically.

1 Credit CME

JAMA

Published Online: February 8, 2022

JAMA Diagnostic Test Interpretation

Article Information and Disclosures

Kristel K. Leung, MD¹;

Gideon M. Hirschfield, MB, BChir, PhD¹

Author Affiliations

¹Toronto Centre for Liver Disease, Division of Gastroenterology and Hepatology, University of Toronto, Toronto General Hospital, Toronto, Canada

Read article on JAMA Network

Read Case Take Quiz Answer

A previously healthy 50-year-old woman presented with 3 weeks of fatigue, nausea, dark urine, pruritus, and scleral icterus. She was treated for Graves disease approximately 20 years previously and had no known family history of autoimmune disease. She reported rare alcohol use, no consumption of herbal products, no new medications, and no illicit drug use. She had no known viral exposures, recent vaccinations, or recent travel. On examination, she was jaundiced and had epigastric abdominal discomfort, but no edema or encephalopathy. Results of blood testing for hepatitis A, B, and C and COVID-19 polymerase chain reaction testing were negative. Findings of abdominal ultrasonography with Doppler were normal. Laboratory data are shown in the Table.

Take Quiz

Please finish quiz first before checking answer.

A previously healthy 50-year-old woman presented with 3 weeks of fatigue, nausea, dark urine, pruritus, and scleral icterus. She was treated for Graves disease approximately 20 years previously and had no known family history of autoimmune disease. She reported rare alcohol use, no consumption of herbal products, no new medications, and no illicit drug use. She had no known viral exposures, recent vaccinations, or recent travel. On examination, she was jaundiced and had epigastric abdominal discomfort, but no edema or encephalopathy. Results of blood testing for hepatitis A, B, and C and COVID-19 polymerase chain reaction testing were negative. Findings of abdominal ultrasonography with Doppler were normal. Laboratory data are shown in the Table.

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Corresponding Author: Gideon M. Hirschfield, MB, BChir, PhD, Toronto Centre for Liver Disease, Lily and Terry Horner Chair in Autoimmune Liver Disease Research, University of Toronto, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada (gideon.hirschfield@uhn.ca).

Conflict of Interest Disclosures: Dr Hirschfield reported receiving personal fees for consultancy from Intercept Pharma, Cymabay, Genfit, Roche, Pliant, High Tide, Mirum, and GlaxoSmithKline outside the submitted work. No other disclosures were reported.

References

Kasarala G , Tillmann HL . Standard liver tests. Clin Liver Dis (Hoboken). 2016;8(1):13-18. doi:10.1002/cld.562 PubMed Google Scholar Crossref

Kwo PY , Cohen SM , Lim JK . ACG Clinical Guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112(1):18-35. doi:10.1038/ajg.2016.517 PubMed Google Scholar Crossref

Valenti L , Pelusi S , Bianco C , et al. Definition of healthy ranges for alanine aminotransferase levels: a 2021 update. Hepatol Commun. 2021;5(11):1824-1832. doi:10.1002/hep4.1794 PubMed Google Scholar Crossref

Bussler S , Vogel M , Pietzner D , et al. New pediatric percentiles of liver enzyme serum levels (alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase): effects of age, sex, body mass index, and pubertal stage. Hepatology. 2018;68(4):1319-1330. doi:10.1002/hep.29542 PubMed Google Scholar Crossref

Marchesini G , Avagnina S , Barantani EG , et al. Aminotransferase and gamma-glutamyltranspeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome. J Endocrinol Invest. 2005;28(4):333-339. doi:10.1007/BF03347199 PubMed Google Scholar

Newsome PN , Cramb R , Davison SM , et al. Guidelines on the management of abnormal liver blood tests. Gut. 2018;67(1):6-19. doi:10.1136/gutjnl-2017-314924 PubMed Google Scholar Crossref

Tran AN , Lim JK . Care of the patient with abnormal liver test results. Ann Intern Med. 2021;174(9):ITC129-ITC144. doi:10.7326/AITC202109210 PubMed Google Scholar Crossref

Mack CL , Adams D , Assis DN , et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American Association for the Study of Liver Diseases. Hepatology. 2020;72(2):671-722. doi:10.1002/hep.31065 PubMed Google Scholar Crossref

Galvin Z , McDonough A , Ryan J , Stewart S . Blood alanine aminotransferase levels >1,000 IU/l: causes and outcomes. Clin Med (Lond). 2015;15(3):244-247. doi:10.7861/clinmedicine.15-3-244 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.