Boulton R, Hamilton M I, Dhillon A P, Kinloch J D, Burroughs A K
University Department of Medicine, Royal Free Hospital, London, England.
Gastroenterology. 1995 Oct;109(4):1324-7. doi: 10.1016/0016-5085(95)90595-2.
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.
将患者转诊给肝病专家的一个常见原因是血清转氨酶水平持续异常并伴有模糊的全身症状。在英国，这些异常情况最常见的原因是与肥胖或酒精滥用相关的脂肪肝；较少见的原因是慢性肝病，尤其是慢性病毒性肝炎、自身免疫性肝炎或慢性胆道疾病。内分泌疾病很少是这些异常的原因，尽管甲状腺功能减退和甲状腺功能亢进是公认的病因。文献中仅由R.G.奥尔森报道过1例艾迪生病作为伴有全身症状的转氨酶水平升高的病因；肝病学教科书中未提及。本文报道了3例艾迪生病患者，他们在肾上腺功能减退被识别之前，血清转氨酶水平升高均超过6个月，在接受类固醇替代治疗后恢复正常。在没有脂肪肝以及病毒和自身免疫标志物证据的情况下，肝病专家应考虑亚临床艾迪生病是伴有全身症状的转氨酶水平持续升高的一个原因。
