title: Subclinical Addison's disease: a cause of persistent abnormalities in transaminase values.
abstract: A common reason for referring patients to hepatologists is persistently abnormal serum transaminase levels with vague constitutional symptoms. In the United Kingdom, these abnormalities are most often caused by a fatty liver either related to obesity or alcohol abuse; they are less commonly caused by chronic liver disease, particularly chronic viral hepatitis, autoimmune hepatitis, or chronic biliary disease. Endocrine disease is rarely a cause of these abnormalities, although hypothyroidism and hyperthyroidism are well-recognized causes. Addison's disease has been only reported once in the literature by R. G. Olsson as a cause of increased transaminase levels associated with constitutional symptoms; it is not mentioned in textbooks on hepatology. Three patients with Addison's disease are reported here, all of whom had increased serum transaminase levels for more than 6 months before the recognition of the hypoadrenalism with resolution to normal after steroid replacement. Hepatologists should consider subclinical Addison's disease as a cause of persistently increased transaminase levels with constitutional symptoms in the absence of evidence for fatty liver as well as viral and autoimmune markers.
authors.affiliation: University Department of Medicine, Royal Free Hospital, London, England.
authors.forename: R
authors.initials: R
authors.lastname: Boulton
authors.forename: M I
authors.initials: MI
authors.lastname: Hamilton
authors.forename: A P
authors.initials: AP
authors.lastname: Dhillon
authors.forename: J D
authors.initials: JD
authors.lastname: Kinloch
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000224:Addison Disease / Q000175:diagnosis / Q000201:enzymology*; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D000637:Transaminases / Q000097:blood*
chemical_list: D000637:Transaminases; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase