Differential Diagnosis for Elevated ALT from Young Age with No Obesity or Diabetes
Single Most Likely Diagnosis
- Non-Alcoholic Fatty Liver Disease (NAFLD) variant without obesity: Although less common, NAFLD can occur in non-obese individuals, especially if there's a strong family history or other metabolic risk factors. The absence of obesity does not rule out NAFLD entirely.
Other Likely Diagnoses
- Viral Hepatitis (B or C): Chronic viral hepatitis can cause elevated liver enzymes from a young age, especially if the infection was acquired perinatally or in early childhood.
- Autoimmune Hepatitis: This condition can present at any age and may cause elevated liver enzymes due to the immune system attacking the liver.
- Wilson's Disease: An inherited disorder that leads to copper accumulation in the liver, causing damage and elevated liver enzymes. It typically presents in the first few decades of life.
- Alpha-1 Antitrypsin Deficiency: A genetic disorder that may cause liver disease and elevated liver enzymes, often presenting in childhood or young adulthood.
Do Not Miss Diagnoses
- Hemochromatosis: A genetic disorder leading to iron overload, which can cause liver damage and elevated liver enzymes. Early diagnosis is crucial to prevent long-term complications.
- Budd-Chiari Syndrome: A rare condition caused by thrombosis of the hepatic veins, which can lead to liver dysfunction and elevated liver enzymes. It's essential to consider this diagnosis due to its potential for severe outcomes if not treated promptly.
Rare Diagnoses
- Glycogen Storage Diseases: A group of inherited disorders that affect glycogen metabolism, some of which can cause liver enlargement and elevated liver enzymes.
- Mitochondrial Disorders: Conditions that affect the mitochondria, such as mitochondrial myopathies, can have systemic effects, including liver enzyme elevation.
- Cystic Fibrosis: Although primarily known for its respiratory effects, cystic fibrosis can also cause liver disease due to thickened bile and may result in elevated liver enzymes.
- Schistosomiasis: A parasitic infection that can cause liver fibrosis and elevated liver enzymes, more common in endemic areas.