Dear Dr. Steiner,
as far as I know there is no such thing as a macro GGT. However, isolated
increase of GGT such as you described could be a biomarker of a few
conditions like: obesity, nonalcoholic steatohepatitis (NASH), anatomic
anomalies related to the papilla Vateri and/or papilla duodeni major,
liver hypoxia or hypoxia of intestines caused by thrombi or other causes.
Maybe determination of lactate, arterial oxygen and oxygen saturation or
even D-dimers could be of some help. Some other things in their early form
could also cause isolated GGT increase for example bile stones (sand in a
duct), autoimmune diseases of liver and/or a bile duct or even metastatic
liver disease. Even some intestinal infections could cause a mild increase
of GGT for a prolonged period of time. Is your patient on some kind of
diet (especially with milk products)? Does she drink soft drinks that
contain taurine (red bull or similar)? GGT is correlated with
triglycerides (it is a membrane bound enzyme). What is the value of her TG
concentration? Is she exposed to the high concentrations of lipophilic
compounds (carcinogenes) like organic solvents? Finally, chronic alcohol
(or drug) abuse could cause increased GGT values even when a person do not
use alcoholic beverages or certain drugs for a few years. More info is
needed. Hope this helps.
Zeljko Debeljak, PhD
Medical Biochemistry Specialist
Osijek Clinical Hospital
CROATIA
> Dear colleagues,
>
> A GP asks about the differential diagnosis of increased GGT in a 20 year
> old young lady. She is perfectly fine except for slightly elevated GGT
> (appr 2.5 upper limit) which has been persisting for a couple of months.
> Transaminases, bilirubin, alkaline phosphatase, and LDH are normal. No
> evidence of drugs, alcohol, and current therapy of any kind including
> hormonal contraception.
>
> One suggestion was early-stage primary biliary cirrhosis (or similar). Any
> comments on that one?
>
> What I am confused most about is that the increase concerns ONLY and
> EXCEPTIONALLY GGT. Any idea if a macro-GGT has ever been described? If so,
> any advice how rule in/out a macro-GGT?
>
> Your suggestions will be much appreciated.
>
> Best regards,
>
> Mike
>
> Dr Michael Steiner
> Medizinisches Labor Rostock
> Suedring 81
> D-18059 Rostock
> GERMANY
>
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