title: Isolated persistent elevation of alanine transaminase for early diagnosis of pre-symptomatic Wilson's disease in Chinese children.
abstract: BACKGROUND
  Recent studies presented a contradictory approach for the investigation of pediatric patients with an isolated increase in alanine transaminase. While classical teaching advised for a thorough investigation, recent studies suggested the yield on further investigation was low and thus not necessary. Yet the approach to the same clinical problem may need to be different due to variable disease prevalence rates among different ethnic populations. For the population with a higher prevalence rate of genetic liver diseases like Wilson's disease, an abnormal liver function may be the first presenting feature for some patients.
  
  
  METHODS
  We reviewed 10 Chinese children with Wilson's disease who were diagnosed at a presymptomatic stage because of an isolated persistent elevation of alanine transaminase.
  
  
  RESULTS
  All 10 patients did not have overt symptoms of liver impairment or neurological deficit. They were picked up incidentally with an abnormal liver function test. All patients were started on treatment shortly after diagnosis, and they remained well and symptom-free on the latest follow-up.
  
  
  CONCLUSIONS
  This case series illustrated that an isolated persistent elevation of alanine transaminase is an important clue to the early diagnosis of pre-symptomatic Wilson's disease. It is particularly relevant in the Asian population where the disease is more prevalent.
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, China, joanniehui@cuhk.edu.hk.
authors.forename: Joannie
authors.initials: J
authors.lastname: Hui
authors.forename: Yuet-Ping
authors.initials: YP
authors.lastname: Yuen
authors.forename: Chung-Mo
authors.initials: CM
authors.lastname: Chow
authors.forename: Josephine
authors.initials: J
authors.lastname: Chong
authors.forename: Grace
authors.initials: G
authors.lastname: Chiang
authors.forename: Chi Keung
authors.initials: CK
authors.lastname: Cheung
authors.forename: Eric L K
authors.initials: EL
authors.lastname: Law
authors.forename: Chloe Miu
authors.initials: CM
authors.lastname: Mak
authors.forename: Ching-Wan
authors.initials: CW
authors.lastname: Lam
authors.forename: Patrick M P
authors.initials: PM
authors.lastname: Yuen
authors.forename: Nelson L S
authors.initials: NL
authors.lastname: Tang
mesh_terms: D000251:Adenosine Triphosphatases / Q000235:genetics; D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D027682:Cation Transport Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D000073840:Copper-Transporting ATPases; D042241:Early Diagnosis; D005234:Fatty Liver / Q000473:pathology; D005260:Female; D006527:Hepatolenticular Degeneration / Q000175:diagnosis*; D006723:Hong Kong; D006801:Humans; D008297:Male; D009154:Mutation; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D027682:Cation Transport Proteins; D000410:Alanine Transaminase; D000251:Adenosine Triphosphatases; D000073840:Copper-Transporting ATPases