Elevated GPT and Indirect Bilirubin Levels: Causes and Concerns

Elevated GPT/indirect bilirubin slightly elevated?

Over the past 10 years of regular health check-ups, my GPT/GOT/total bilirubin levels have all been within normal ranges, with GPT/GOT between 10-20.
In August 2018, total bilirubin was first noted at 1.8 (with GPT/GOT around 20 at that time).
In September, a follow-up test showed total bilirubin still slightly elevated, but GPT/GOT had increased to 40.
Additionally, AFP levels have consistently ranged from 7 to 10 over the past decade.
Subsequent examinations, including an abdominal ultrasound, showed normal results with no evidence of hepatitis B or C, and no fatty liver.
ANA tests were normal, and thyroid-related tests were also normal.

In later follow-ups, total bilirubin was approximately 1.4 (with direct bilirubin normal and indirect bilirubin slightly elevated).
GPT increased from 40 (last September) to 41 (last December) and then to 49 (this June), while GOT remained around 35 in all three tests.
The ultrasound examination continued to show normal results.
Initially, the doctor suspected Gilbert's syndrome, but literature indicates that Gilbert's syndrome only causes bilirubin abnormalities and does not affect liver enzyme levels.
Moreover, my values have been around 20 for the past 10 years, making the current values seem unusual in comparison.
(One family medicine doctor suggested that Gilbert's syndrome could affect GPT and AFP levels, but the literature states otherwise.)
Therefore, I would like to inquire about the following:
1.
Does Gilbert's syndrome truly affect liver function indices? Is it typical for Gilbert's syndrome to present later in life, such as at age 37?
2.
Should I undergo any further testing, or is observation sufficient?
3.
If the elevated levels are due to formaldehyde or benzene exposure from home renovations, would this lead to severe inflammation or other abnormalities in blood tests?
Last year, my husband experienced an unknown hepatitis (despite a liver biopsy, the cause remained undetermined), and it took about a year for his liver function to return to normal from over 900.
Since the cause is unknown, coupled with my situation, I am concerned whether it could be related to issues stemming from our home renovations.
I apologize for the lengthy message and thank you in advance for your assistance.

mini, 30~39 year old female. Ask Date: 2019/07/05

Dr. Chen Shidian reply Gastroenterology and Hepatology

The condition is somewhat different from others, but still poses no danger.
It is recommended to continue monitoring at the same healthcare facility.
Maintain a normal diet and avoid exposure to toxic volatile substances.
Referral to a medical center should only be made if necessary.

Reply Date: 2019/07/05

More Info

Understanding elevated GPT (Glutamate Pyruvate Transaminase) and indirect bilirubin levels can be quite complex, especially when considering the potential implications for liver health. Based on your detailed medical history, it appears that you have been experiencing fluctuations in liver function tests, particularly with elevated GPT levels and indirect bilirubin. Let's break down your concerns and questions systematically.

1. Gilbert's Syndrome and Liver Function Tests
Gilbert's syndrome is a common genetic condition characterized by mildly elevated levels of unconjugated (indirect) bilirubin due to reduced activity of the enzyme UDP-glucuronosyltransferase. This condition is generally benign and does not typically lead to significant liver dysfunction or elevated liver enzymes like GPT or GOT. While Gilbert's syndrome primarily affects bilirubin levels, it is not known to cause significant elevations in liver enzymes.
However, it is possible for individuals with Gilbert's syndrome to have fluctuations in liver enzyme levels due to other factors, such as medications, alcohol consumption, or other liver conditions. It is unusual for Gilbert's syndrome to present later in life, as it usually manifests during adolescence or early adulthood. Therefore, your recent elevation in GPT levels may suggest that there is another underlying issue that needs to be investigated further.

2. Further Investigations
Given your history of elevated GPT and bilirubin levels, it would be prudent to conduct additional tests to rule out other potential liver conditions. These may include:
- Hepatitis Panel: To check for viral hepatitis (A, B, C).

- Autoimmune Markers: Such as ANA (Antinuclear Antibody) and SMA (Smooth Muscle Antibody) to rule out autoimmune hepatitis.

- Liver Function Tests: Including tests for alkaline phosphatase and gamma-glutamyl transferase (GGT) to assess for cholestasis or biliary obstruction.

- Imaging Studies: While your ultrasound was normal, consider a more detailed imaging study like a CT scan or MRI if symptoms persist or worsen.

- Liver Biopsy: In certain cases, a biopsy may be warranted to assess for histological changes in the liver.

3. Environmental Factors
You mentioned concerns about potential exposure to formaldehyde or benzene from home renovations. Chronic exposure to certain chemicals can indeed lead to liver damage, but this typically presents with more severe symptoms and significant liver enzyme elevations. If you suspect that your environment may be contributing to your liver issues, it would be wise to consult with an environmental health specialist. They can help assess your exposure and recommend appropriate testing or remediation strategies.

Conclusion
In summary, while Gilbert's syndrome is unlikely to be the sole cause of your elevated GPT levels, it is essential to explore other potential causes. Regular monitoring of your liver function tests is crucial, and any significant changes should prompt further investigation. If you have concerns about environmental exposures, addressing those with a specialist may provide additional insights.
It's important to maintain open communication with your healthcare provider, who can guide you through the necessary steps for diagnosis and management. Regular follow-ups and a proactive approach to your health will be key in managing your liver function and overall well-being.

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