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Gastroenterology  (Expert Forum)
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24 YO male w/ elevated AST and ALT levels, what should I think?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
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MedHelp Member's Question

24 YO male w/ elevated AST and ALT levels, what should I think?

by jim1618, Mar 19, 2003 12:00AM
I have kind of a long question, so please bear with me..



I am 24, male, and am in excellent health ( I was have been competitive at the elementary - varsity collegiate level for distance running and have been active my whole life).  I have no history of genetic liver disorders, cancer, or any other problems in my family, do not have hepatitis, and do not use drugs or alchohol.  I also show no symptoms of liver damage.



2 Days ago, I had a routine liver panel prior to a prescrition for propecia.  It came back abnormal only in the level of AST and ALT, 472 and 117 repectively.  My doctor ordered another test (only 17 hours later) and I still tested high 469 and 139.



Now I am getting worried because my doctor has scheduled an ultrasound and refered me to a specialist for review at UCLA medical center.  



I have been pouring over numerous materials on the internet and, because of my abnormaly high AST/ALT ratio, have found that I am likely to have liver disease from alchohol.  I think this is impossible because I don't abuse alchohol.  So from what I can tell, the only other possabilities for this high ratio would Cerhitis or some sort of tumor?  



One other thing I noted is that AST level also monitor skeletal muscle and heart tissue damage.  I did do an extremely hard workout on 1 1/2 days before my test and my arms were still sore to the point that I couldn't sraighten them even during the second test.  I think I definetly had some damage there so I'm not sure if that would affect my AST levels...



The number of different possibilities are making my head spin...I have ultrasound in more than a week and don't want to walk around nervous that whole time...



Could you please tell me

1) Is it really possible someone my age might have serious liver problems?

2) What would you interpret the function test might mean for me specifically?

3) Is it possible this test was flawed because of the workout or other reasons?

4) Shoudn't my two liver tests have been farther apart?

5) Based on my information, what would you guess the problem to be?

6) Shoud I be concerned this could be liver cancer?



Thanks for your honest opinion,

Jim
Doctor's Answer

by Kevin Pho, MD, Mar 20, 2003 12:00AM
Hello - thanks for asking your question.



Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.



1) There are several liver diseases that can occur any age.  Examples would include hemochromatosis and chronic hepatitis.  



2) It is difficult to say without further testing.  A referral to a specialist and ultrasound are reasonable next steps.  Here are some potential causes:



Medications — Almost any medication can cause an elevation of liver enzymes. Common ones include nonsteroidal anti-inflammatory drugs, antibiotics, cholesterol medications, antiepileptic drugs, and antituberculous drugs.



Alcohol abuse — The diagnosis is supported by an AST to ALT ratio of 2:1 or greater.



Hepatitis B or C



Hereditary hemochromatosis — Hereditary hemochromatosis (HHC) is a common genetic disorder.  Screening should begin with a serum iron, total iron binding capacity (TIBC), and ferritin levels.



Hepatic steatosis and steatohepatitis — Hepatic steatosis and an associated condition, non-alcoholic steatohepatitis (NASH), may present solely with mild elevations of the serum aminotransferases.



3) I wouldn't attribute it to exercise.  I would ensure that liver causes are ruled out first.



4) Not necessarily.  Different liver diseases can present with different patterns in liver transaminases.



5) I cannot say without more information.  It can be any of the diseases mentioned above.  More tests (ultrasound, hepatitis screen, possible biospy) are needed.



6) The mean age of presentation of liver cancer is between 50 and 60.  To be completely sure, imaging would have to be performed.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (9)

by surgeon, Mar 20, 2003 12:00AM
Liver cancer? Almost certainly not!!!! Due to your working out? Possibly. Serious? The numbers are really not very high, and are likely to mean nothing at all. A biopsy of the liver (a needle, fairly simple) would be one way to tell, but before that it's reasonable simply to plan a re-test in a couple of weeks or longer. Could someone your age have serious liver problems? Hepatitis (inflammation, due to various things including infection, drugs, immune diseases) is possible at nearly any age, but usually the numbers are much higher, and in fact most serious conditions would have more dramatic numbers. I'd guess it will turn out to be nothing important, and in fact that a specific diagnosis may never be made. Before doing much else, I'd think a repeat of the tests over a longer interval would make sense.

by roxnsox, Mar 20, 2003 12:00AM
Go to the website of the American Liver Foundation.  It is www.liverfoundation.org.  

   Do some research on Nonalcoholic Steatohepatitis (NASH)

  

   Good luck.



by jim1618, Mar 20, 2003 12:00AM
Surgeon,



Thanks for your comments.  I talked to my physician about doing another panel test before I see that speacialist and she thought it was a good idea.





Roxnsox,



Interesting that after all my reading, NASH was one of the major possibilities I considered.  However, I did see some research indicating that in a study done of NASH patients, the mean of their AST/ALT ratios were less than one.  Also, the range didn't indicate any values higher than 2.6.  



I noticed you were diagnosed with NASH from earlier posts, can you tell me what your liver panel tests showed when you were being diagnosed?



Thanks!



Jim

by roxnsox, Mar 20, 2003 12:00AM
My pre-diagnosis ALT was 67 and AST was 57.  They have returned to the normal range now.  I felt really awful for years and years.  I couldn't get my doctor to take me seriously.  Finally changed doctors and was properly diagnosed.  I did a little reaserch on the internet and found that the National Institute of Health was doing a clinical trial on this Liver disease so I went there and participated in it.  Pa