Clinical Chemistry
Contributed by Simmi Patel, MD and Octavia Peck-Palmer, PhD
CASE PRESENTATION
A male in his early twenties was found to have elevated Gamma Glutamyl Transferase (GGT) incidentally during his work up for medical clearance for the US armed forces. Patient's past medical history is significant for Acute Lymphoblastic Leukemia (ALL) when he was in preschool. Patient received chemotherapy followed by bone marrow transplant. He completed his chemotherapy treatment three years later. Follow up showed no recurrence. Patient's social history includes social alcohol use of 4-5 beers every weekend. Patient denies smoking and/or use of recreational drugs. In addition to exercising daily, patient takes a number of unknown health supplements. Of note, patient recalls having an elevated GGT level when he was in the 5th grade, 3 years after he completed chemotherapy during a wellness check however the cause was unknown. Physical exam is non-contributory. BMI is 25. The results of the initial laboratory tests are listed in Table 1.
As a result of an unusually elevated GGT level, patient was advised to avoid alcohol. Abdominal ultrasound was ordered, and the impression was normal. Several liver enzyme functional tests were conducted and were found to be within normal limits (Table 2).
Due to the continued elevation of GGT, repeat laboratory tests were conducted (Table 3).
In order to determine the presence of liver dysfunction, urine organic acid was also ordered. In general, over-representation of alpha ketoglutarate and tyrosine catabolites (4-hydroxyphenyllactate, 4-hydroxyphenylpyruvate) would suggest liver function problems. The result was normal with no elevation of metabolites.