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January 1992

Alanine Aminotransferase in Clinical Practice

Author Affiliations

Farmington, Conn

Arch Intern Med. 1992;152(1):208. doi:10.1001/archinte.1992.00400130196033

To the Editor. —  The thoughtful review by Sherman1 provides a useful approach to the practicing physician. He makes the recommendation that elevations of alanine aminotransferase levels less than twofold not be pursued even if they persist for 6 weeks or more. Although this appears a useful strategy in general, some forms of liver disease may benefit from a slightly different approach. He fails to include environmental and occupational exposures in his list of potential causes. This is a common omission; several recent reviews2-4 of fatty liver disease have similarly failed to suggest hepatotoxin exposure as a potential cause of elevated alanine aminotransferase levels in practice. Outbreaks of occupational liver disease are, nevertheless, well described.5,6,6 A case-control study7 of randomly occurring fatty liver disease has similarly suggested that hepatotoxin exposure may be an important risk factor. Four further cases with less than twofold elevations of alanine