A rare cause of elevated liver enzymes: Addisons disease
Neslihan Cuhaci1, Aylin Bolat Demirezer2, Didem Ozdemir Sen1, Reyhan Ersoy1, Osman Ersoy2 & Bekir Cakir1
Introduction: Common reasons of chronically elevated liver enzymes are; fatty liver associated with alcohol abuse or obesity, chronic viral hepatitis, autoimmune hepatitis, chronic bilier disease and hereditary metabolic disorders. Adrenocortical insufficiency can also cause elevated liver enzymes. Until now, there are few cases in the literature with abnormal liver function associated with Addisons disease. We reported this case to kept mind the Addisons disease while investigating the hypertransaminasaemia.
Case report: A 49-years-old woman admitted to our hospital with a 2 months history of weakness, fatigue and increased skin pigmentation. Her laboratory tests revealed low serum cortisol (2.9 μg/dl), increased adrenocorticotrophing hormone (ACTH) (>1250 pg/ml), aspartate transaminase (AST) and alanine transaminase (ALT) levels (120 U/ml and 87 U/ml respectively). Nevertheless, hyponatremia and hyperkalemia were not noted. Increased skin pigmentation, low serum cortisol, and high ACTH levels suggested Addisons disease. Diagnosis was confirmed by ACTH stimulation test. No cortisol response was taken to ACTH stimulation test. 21-hydroxylase antibody was found positive. She had also evaluated for hypertransaminasaemia. Liver and spleen were not palpable. No lymphadenopathy was found. Other liver function tests were all normal. All viral hepatitis markers and tests for autoimmune hepatitis (antibodies against smooth muscle, mitochondria and nuclei) were negative. Abdominal tomography showed no pathology for liver and adrenal glands. When the Addisons disease was confirmed by ACTH stimulation test, glucocorticoid therapy was given. Nearly 2 weeks after replacement therapy aminotransferase activity returned in normal range.
Conclusion: For patients with constantly elevated liver enzymes extra-hepatic diseases should have to be considered. Although rare, Addisons disease should be kept in mind.