I have found references (but have no experience of)
which speculate on the presence of macro-GGT-
1) http://www.clinchem.org/cgi/reprint/31/10/1743.pdf
2)www.revespcardiol.org/cgi-bin/wdbcgi.exe/cardio/mrevista_cardio.fulltext?pident=434
- 72k -
3)
http://acb.rsmjournals.com/cgi/content/abstract/40/5/514
There are reported cases of macro-amylase, macro-CK,
macro-LDH, etc, so why not a macro-GGT?.
I am not sure if you might get a clue from her IgG?
Regards
David Brown
--- Željko Debeljak <[log in to unmask]> wrote:
> 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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