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Michael, Gamma-glutamyl transferase in the serum is of hepatic microsomal origin and increase in its activity in the blood is usually explained by induction of synthesis or by alteration of cellular structure (i.e. increased permeability of the hepatocyte membrane). The situation you report is suggestive of increased cell permeability and leakage of the enzyme from the hepatocyte, which can be genetic (I've seen it in families) or can result from a previous toxic insult. I would suggest serum bile acids and glutathione-S-transferase activity as further tests (apart from the obvious ones). It is probably not a cause for concern if you don't find anything else wrong. Regards, Nick Miller London 2008/10/10 Dr. Michael Steiner <[log in to unmask]>: > 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 > > ------ACB discussion List Information-------- > This is an open discussion list for the academic and clinical > community working in clinical biochemistry. > Please note, archived messages are public and can be viewed > via the internet. Views expressed are those of the individual and > they are responsible for all message content. > ACB Web Site > http://www.acb.org.uk > List Archives > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > List Instructions (How to leave etc.) > http://www.jiscmail.ac.uk/ > ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/