What does elevated transaminase mean?

Transaminitis, or hypertransaminasemia, refers to unusually high levels of a family of enzymes called transaminases. Transaminitis is not a disease, but it can point to other issues that require treatment. High levels of fat or similar problems may be causing inflammation in the liver.

Transaminases play key roles in the liver. They help the organ's cells to function, break down substances, and remove toxins from the body.

When a person has elevated levels of these liver enzymes, there may be no apparent cause, and levels often return to a normal range without treatment.

However, transaminitis can be associated with serious conditions. It is important to explore why levels are high and diagnose any underlying issue.

Common causes and treatments

Diagram of the liver with possible transaminitis

Transaminases play a key role in the liver.

According to the American Academy of Family Physicians, the following factors can lead to elevated levels of transaminases:

nonalcoholic fatty liver disease

alcoholic liver disease

viral hepatitis

hemochromatosis

certain medications

Transaminitis is less commonly caused by:

alpha-1 antitrypsin deficiency

autoimmune hepatitis

Wilson's disease

other health conditions

Nonalcoholic fatty liver disease

This condition develops when there is too much fat in the liver cells, and up to 30 percent of adults in the United States may have it.

Risk factors include obesity and high cholesterol, but the exact cause is unknown. There are often no symptoms when the disease is at an early stage, but some people experience fatigue or mild pain in the upper-right area of the abdomen.

Continual damage can eventually lead to scarring, or cirrhosis, which significantly impacts the liver's function.

The following strategies can prevent or help to combat fatty nonalcoholic liver disease:

eating a healthful, balanced diet

exercising regularly

maintaining a healthy weight

Alcoholic liver disease

Damage caused by excessive consumption of alcohol leads to this condition, which is also called alcohol-related liver disease.

In early stages, there are typically no symptoms. In later stages, symptoms include:

blood in the stool or vomit

confusion

drowsiness

jaundice (yellowing) of the skin and eyes

nausea

a swollen abdomen

swollen ankles

weight loss

A study published in 2010 included 256 participants with mild transaminitis. Alcohol consumption was reportedly the cause of fatty liver disease in 10 percent of cases.

It is essential to give an accurate report of alcohol consumption. Otherwise, it can be difficult for a doctor to distinguish between these types of liver disease with a biopsy or other simple diagnostic tools.

Treatment for alcohol-related liver disease involves abstaining from alcohol and making lifestyle changes similar to those recommended for people with nonalcoholic fatty liver disease.

When alcohol-related liver disease is severe, a person may require medication or a transplant.

Viral hepatitis

Hepatitis refers to a type of liver inflammation. It is commonly caused by a viral infection, usually hepatitis B or hepatitis C.

The following are symptoms of both types of infection:

abdominal pain

dark urine

fatigue

fever

jaundiced skin and eyes

joint and muscle pain

a loss of appetite

nausea

vomiting

Both types of infection can last for a few weeks or develop into serious lifelong conditions. Only about 6–10 percent of adults and older children infected with hepatitis B develop a chronic condition. However, most people develop chronic hepatitis C once infected.

Treatment for short-term hepatitis infection involves:

resting

staying hydrated

managing symptoms

Chronic infections are monitored and treated with antiviral medications. Untreated viral hepatitis can cause early, permanent liver damage.

Hemochromatosis

This disease causes too much iron to build up in the body. It is stored in organs such as the liver, heart, and pancreas, where it can contribute to problems such as liver disease and diabetes mellitus.

Hemochromatosis may be hereditary, or it can develop as a result of other conditions, including types of anemia and chronic liver diseases.

People with this disease tend to start experiencing symptoms between the ages of 40 and 60. Symptoms include:

fatigue

impotence

joint and abdominal pain

a loss of libido

problems with the heart, liver, and pancreas

general weakness

Treatment involves regularly drawing blood to reduce the levels of iron, which circulates in the bloodstream. This process is called phlebotomy.

Medications and herbs

Antidepressants in the foreground with a person in the background

Antidepressants may cause transaminitis.

Medications, supplements, and herbs can impact the health of the liver because it processes these products.

Several medicines are known to cause transaminitis. They include:

antidepressants, such as bupropion (Wellbutrin)

antibiotics, such as isoniazid (Nydrazid)

pain relievers, including acetaminophen (Tylenol)

nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin)

antifungals, such as ketoconazole (Nizoral)

muscle relaxants, such as baclofen (Lioresal)

blood pressure-reducing medications, such as losartan (Cozaar) and lisinopril (Zestril)

immune suppressants, such as methotrexate

the antidiabetic drug acarbose (Precose)

the heart medication amiodarone (Cordarone)

Herbal preparations containing the following ingredients may also lead to transaminitis:

kava kava

germander

chaparral

senna

ephedra

Also, high doses of vitamin A can damage the liver.

If medications or supplements are leading to elevated levels of transaminases, a doctor may recommend reducing the dosage or switching treatments.

Some people may need regular blood tests while taking medications to ensure that they are not interfering with the liver or its enzyme levels.

Less common causes

Rarely, the following conditions can lead to transaminitis:

Alpha-1 antitrypsin deficiency

This genetic disorder damages the liver and lungs. The degree of damage can vary from raised levels of transaminases to liver failure.

Approximately 15 percent of adults with this disorder develop scarring of the liver. They also have a higher risk of developing a form of liver cancer called hepatocellular carcinoma.

Symptoms associated with alpha-1 antitrypsin deficiency include:

a swollen abdomen

swollen feet or legs

jaundice of the skin and eyes

This disorder also causes lung-related symptoms, which typically appear between the ages of 20 and 50. They include shortness of breath, wheezing, a rapid heartbeat, and fatigue.

An alpha-1 antitrypsin deficiency can be diagnosed with a blood test or genetic testing. There is no cure, so treatment is aimed at managing symptoms.

Autoimmune hepatitis

This occurs when the immune system attacks the liver's cells, but the cause is not fully understood.

Symptoms of autoimmune hepatitis include:

abdominal pain

an enlarged liver

fatigue

jaundice

joint pain

a loss of menstruation

rashes

the appearance of small blood vessels on the skin

Autoimmune hepatitis can cause scarring of the liver if left untreated, and it can eventually lead to liver failure. Treatments include immune-suppressing medications or a liver transplant.

Wilson's disease

This rare inherited disorder causes copper to collect in organs such as the liver and brain. It can become life-threatening if levels of copper are too high.

Symptoms include:

abdominal pain

coordination problems

copper coloring around the eyes, known as Kayser-Fleischer rings

difficulty speaking or swallowing

fatigue

jaundice

a loss of appetite

stiff muscles

swelling in the legs or abdomen

uncontrolled movements

Wilson's disease can be diagnosed using:

blood tests

genetic tests

a liver biopsy

The condition can be managed with medications that remove excess amounts of copper and prevent further buildups.

Other medical conditions

Several conditions that seem unrelated to the liver can cause transaminitis. Often there are no liver-related symptoms.

These conditions include:

thyroid disorders, such as hypothyroidism and hyperthyroidism

celiac disease, in which the immune system reacts to gluten

hemolysis, which is the rupturing of red blood cells

muscle disorders, such as rhabdomyolysis and polymyositis

Diagnosis

Lab worker holding a blood sample

A doctor may order blood tests to diagnose transaminitis.

To diagnose transaminitis, a doctor will take a full medical history and perform a physical examination. They may also order blood tests, and a person will need to fast before these.

The blood tests will determine levels of:

glucose

iron

ferritin

total iron-binding capacity

hepatitis B surface antigen

hepatitis C virus antibody

If levels are normal, a doctor will recommend lifestyle changes and ask the person to attend regular checkups until levels of transaminases go down.

Sometimes, further testing is required. These tests may involve ultrasound imaging, or they may check for levels of blood antibodies.

If levels of transaminases remain high for 6 months, the doctor may order a biopsy.

Home remedies for prevention

To prevent transaminitis:

Eat a balanced diet.

Engage in moderate physical activity on a regular basis.

Maintain a healthy weight.

Seek prompt treatment for viral infections.

Control chronic conditions, such as diabetes mellitus or autoimmune hepatitis, by following a prescribed treatment plan.

Take the recommended dosages of supplements and medicines.

Discuss alternative options, if medications are causing elevated levels of transaminases.

Takeaway

A temporary increase in liver enzymes is not unusual. Often, this situation can be resolved by making lifestyle changes.

The outlook depends on the cause of transaminitis. When a viral infection or chronic infection is responsible for raised levels of transaminases, it is important to work with a doctor to reduce levels and prevent further damage to the liver.

Receiving a diagnosis and treatment early will help to keep symptoms manageable and reduce the risk of complications.