The Reply

We appreciate the excellent comments by Dr. Sargsyan. It is correct that when considering the etiologies underlying elevated serum alanine (ALT) and aspartate (AST) transaminases, one should also consider muscle as a potential source, particularly in the presence of elevated serum creatine kinase,1 before attributing them to liver pathology and moving on to invasive procedures, such as liver biopsy. In these circumstances, and as noted in our review,2 we check for elevation in serum gamma glutamic transferase (GGT) levels, that would suggest liver, rather than muscle pathology.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Letter Source Type: research