Normal Fasting-State Levels of Serum Cholyl-Conjugated Bile Acids in Gilbert's Syndrome: An Aid to the Diagnosis

Authors

  • John M. Vierling,

    1. Liver Unit, NIAMDD, NIH, Bethesda, Maryland 20205; the Polly Annenberg Levee Hematology Center, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029; the Department of Medicine, Albert Einstein College of Medicine, New York, New York 10461; the Division of Gastroenterology, Department of Medicine, Veterans Administration Medical Center and University of Colorado Health Sciences Center, Denver, Colorado 80225; the Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minnesota 55455; the Division of Gastroenterology, Department of Medicine, University of California at San Diego, San Diego, California 92093; and the Department of Medicine, University of California Medical Center, San Francisco, California 94143
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  • Paul D. Berk,

    Corresponding author
    1. Liver Unit, NIAMDD, NIH, Bethesda, Maryland 20205; the Polly Annenberg Levee Hematology Center, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029; the Department of Medicine, Albert Einstein College of Medicine, New York, New York 10461; the Division of Gastroenterology, Department of Medicine, Veterans Administration Medical Center and University of Colorado Health Sciences Center, Denver, Colorado 80225; the Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minnesota 55455; the Division of Gastroenterology, Department of Medicine, University of California at San Diego, San Diego, California 92093; and the Department of Medicine, University of California Medical Center, San Francisco, California 94143
    • Paul D. Berk, M.D., Polly Annenberg Levee Hematology Center, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029.
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  • Alan F. Hofmann,

    1. Liver Unit, NIAMDD, NIH, Bethesda, Maryland 20205; the Polly Annenberg Levee Hematology Center, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029; the Department of Medicine, Albert Einstein College of Medicine, New York, New York 10461; the Division of Gastroenterology, Department of Medicine, Veterans Administration Medical Center and University of Colorado Health Sciences Center, Denver, Colorado 80225; the Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minnesota 55455; the Division of Gastroenterology, Department of Medicine, University of California at San Diego, San Diego, California 92093; and the Department of Medicine, University of California Medical Center, San Francisco, California 94143
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  • James F. Martin,

    1. Liver Unit, NIAMDD, NIH, Bethesda, Maryland 20205; the Polly Annenberg Levee Hematology Center, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029; the Department of Medicine, Albert Einstein College of Medicine, New York, New York 10461; the Division of Gastroenterology, Department of Medicine, Veterans Administration Medical Center and University of Colorado Health Sciences Center, Denver, Colorado 80225; the Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minnesota 55455; the Division of Gastroenterology, Department of Medicine, University of California at San Diego, San Diego, California 92093; and the Department of Medicine, University of California Medical Center, San Francisco, California 94143
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  • Allan W. Wolkoff,

    1. Liver Unit, NIAMDD, NIH, Bethesda, Maryland 20205; the Polly Annenberg Levee Hematology Center, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029; the Department of Medicine, Albert Einstein College of Medicine, New York, New York 10461; the Division of Gastroenterology, Department of Medicine, Veterans Administration Medical Center and University of Colorado Health Sciences Center, Denver, Colorado 80225; the Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minnesota 55455; the Division of Gastroenterology, Department of Medicine, University of California at San Diego, San Diego, California 92093; and the Department of Medicine, University of California Medical Center, San Francisco, California 94143
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  • Bruce F. Scharschmidt

    1. Liver Unit, NIAMDD, NIH, Bethesda, Maryland 20205; the Polly Annenberg Levee Hematology Center, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029; the Department of Medicine, Albert Einstein College of Medicine, New York, New York 10461; the Division of Gastroenterology, Department of Medicine, Veterans Administration Medical Center and University of Colorado Health Sciences Center, Denver, Colorado 80225; the Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minnesota 55455; the Division of Gastroenterology, Department of Medicine, University of California at San Diego, San Diego, California 92093; and the Department of Medicine, University of California Medical Center, San Francisco, California 94143
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Abstract

Fasting levels of cholic acid conjugates were determined by radioimmunoassay in the serum of 24 patients with extensively documented Gilbert's syndrome and in 98 healthy controls without unconjugated hyperbilirubinemia. The Gilbert's syndrome patients studied included all three subtypes, as determined from studies of the plasma disappearance kinetics of sulf obromophthalein and indocyanine green. Although patients with structural liver disease severe enough to produce hyperbilirubinemia almost invariably have elevated fasting serum levels of cholic acid conjugates, values were normal in each of the Gilbert's syndrome patients, including patients with metabolic abnormalities in sulfobromophthalein and indocyanine green transport. It is concluded that the measurement of fasting serum levels of cholic acid conjugates is a useful adjunct to the diagnosis of Gilbert's syndrome.

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