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Alanine Aminotransferase:: A Nonspecific Marker of Liver Disease

Brian F. Mandell, MD, PhD
Arch Intern Med. 1992;152(1):209-213. doi:10.1001/archinte.1992.00400130197038.
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To the Editor. —  Sherman1 in his article on alanine aminotransferase (ALT) provides a thorough review of ALT in relationship to liver disease. However, despite mentioning that the enzyme is present in "many tissues in the body," the review perpetuates the clinical lore that "liver function tests" do indeed reflect hepatic disease. The article states that "persistent... elevations in ALT values... imply the presence of chronic liver disease." This may be true in the majority of patients examined and referred to a gastroenterologist. However, I believe that it is important to emphasize that acute or chronic elevations of ALT can also reflect muscle injury and inflammation.The pattern of aspartate aminotransferase elevation greater than that of ALT can be seen in polymyositis2 and rhabdomyolysis, as well as in alcoholic liver injury. I have seen three cases referred for liver biopsy with such a pattern that turned out to


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