Two enzymes may be elevated:aspartate transaminase (AST)or alanine transaminase (ALT).
Transaminitis is also called hypertransaminasemia, transaminase elevation, or elevated liver enzymes.
However, only 5% or less of these people have a serious problem with theirliver.
Verywell / Gary Ferster
Symptoms
Elevated transaminase enzymes may be an indicator of medical conditions that can cause certain symptoms.
These might include:
However, in many cases, people have elevated transaminase enzymes without having any symptoms.
This may be especially likely if the elevations in these enzymes are not severe.
Damage to the liver can cause many different symptoms and problems.
They are also called aminotransferases.
Usually, the term transaminase is used to refer to the enzymes AST and ALT.
Liver Problems From Medications
Transaminases might also be elevated as a reaction to certain medications.
This might be particularly likely if a person is taking more than one medication that might damage the liver.
(This is particularly true of elevations of AST as opposed to ALT).
If your AST and ALT are elevated, you might be told that you have transaminitis.
These can give other information about how the liver and other organs might be functioning.
These tests are often performed as part of the medical diagnosis for a number of different problems.
Sometimes, people learn that they have elevated liver enzymes even when they havent noticed troublesome symptoms.
If you have elevated transaminases, your healthcare provider will want to contextualize this with your overall health.
The amount of elevation is also an important diagnostic clue.
For example, very high levels of transaminases likely indicate more severe, recent liver damage.
Medical history and exams are also important to consider.
These can help your healthcare provider gain clues about the potential causes of your elevated transaminases.
For example, its important that your healthcare provider ask you about your alcohol intake and your medications.
Additional medical tests may also be needed.
If transaminase levels dont go down with treatment, follow up tests might be needed.
These might include:
In difficult-to-diagnosis situations, a referral to a gastroenterologist may be helpful.
Diagnosis Caveats
Elevated transaminases are not always a good indicator of how well the liver is functioning.
With mild increases, there might be damage to the liver, but not enough to impair its functions.
Also, increases in transaminases (particularly AST) can sometimes be sparked by other kinds of medical problems.
Additionally, sometimes people may have severe liver damage but not necessarily elevated transaminases.
High levels of AST and ALT usually indicate significant ongoing damage to the liver.
In this case, other tests can help fill out the clinical picture.
Treatment
Elevated transaminases may indicate that you need treatment of some sort.
This will depend on the underlying cause and its severity.
People with symptoms of liver disease along with elevated transaminases may need more prompt interventions.
For example, if your healthcare provider suspects MASLD, lifestyle interventions are usually the first recommended treatment.
You may need repeat AST, ALT, and other liver function tests after you start your treatment.
This can help show how well you are responding to the treatment.
Sometimes these tests reveal that mildly elevated levels of transaminases have gone down, even without treatment.
Even if you dont have symptoms now, your liver might be becoming gradually more damaged over time.
Eventually, this might cause life-threatening liver failure.
Taking steps now may help you prevent long-term problems.
It might be especially surprising if you had no idea that your liver could be at risk.
However, try not to panic.
Your healthcare provider will probably need to find out more to let you know what is going on.
Dont hesitate to ask if you have any questions about possible diagnosis or treatment.
Less common causes includedrug-induced liver injury,hepatitis Bandhepatitis C, andhereditary hemochromatosis.
The occurrence of symptoms will depend on the underlying medical condition as well as the severity of enzyme elevation.
A liver panel can determine if the liver is working as expected.
Stellpflug SJ.Transaminitis: the lab test that has inflammation.J Med Toxicol.
2015;27(1):1-7. doi:10.1097/MEG.0000000000000233
Shah NJ, John S.Acute and chronic liver failure.
Testing.com.Alanine aminotransferase (ALT).
2017;96(11):709-715.
2012;5(1):6. doi:10.1186/1756-6614-5-6
Al-Busafi SA, Hilzenrat N.Mild hypertransaminasemia in primary care.ISRN Hepatol.
2020;115(7):1075-1083. doi:10.14309/ajg.0000000000000717
