Incidental hypertransaminasemia in children: Potential delay in diagnosis of muscle disease

• Main Authors: Carolyne Ghobrial, Nehal Abdelhamid, Hanaa El-Karaksy
• Format: Article
• Language: English
• Published: SpringerOpen 2018-12-01
• Series: Egyptian Pediatric Association Gazette
• Online Access: http://www.sciencedirect.com/science/article/pii/S1110663818300363

Many physicians believe that muscle disease leads either to sole elevation of aspartate aminotransferase (AST) or a disproportionate increase in AST versus alanine aminotreansferase (ALT). We herein report 25 patients with muscle disease who presented erroneously to the hepatologist with an incidental finding of elevated ALT/AST. Data of 25 patients with elevated ALT/AST who proved to have muscle disease and underwent extensive liver workup were analyzed. The time lapse until diagnosis of muscle disease and costs of unnecessary liver workup were calculated. The time interval from the incidental finding of elevated transaminases to diagnosis of skeletal muscle disease ranged between 2 months to 10 years with a median (IQR) of 2 (3.6) years. The mean ALT:AST ratio was 1.24. Creatine phosphokinase (CPK) level correlated positively and significantly with both ALT (p = 0.002) and AST (p = 0.0007). The costs of unnecessary liver workup, before muscle disease was diagnosed, ranged between 5000 and 10,000 Egyptian pounds. Unawareness of physicians with muscle origin of ALT/AST may cause delay in diagnosis of muscle disease. Early determination of CPK could save a lot of stress and money. Keywords: Alanine aminotransferase, Aspartate aminotransferase, Creatine phosphokinase, Skeletal muscle disease