Question: A 70 year old black female is sent to your office with the following LFT profile: AST 55, ALT 72, AP 119, Bil 1.1. Which of the following diagnoses is least likely to explain this abnormality?
A. hereditary hemochromatosis
B. non-alcoholic steatohepatitis
C. hepatic adenoma
Answer: Consult for abnormal LFT (in this case, a hepatocellular rather than cholestatic profile) is common, so you must be able to create an intelligent differential diagnosis. Of course, things like drug toxicity, viral and autoimmune hepatitis and NASH are first line considerations. So is hereditary hemochromatosis…but not in a black patient! Although blacks can have iron overload for other reasons, the classic HFE gene mutation of hereditary hemochromatosis is extremely rare.
Second line considerations include alpha-1 antitrypsin deficiency, Wilson Disease (but not typically in the elderly), celiac sprue and thyroid disorders. Space occupying lesions like adenoma and FNH can cause mild elevations in the hepatocellular profile, and should be considered when first line tests are all normal.