What Does Raised GGT Level Indicate?

Posted on Sat, 26 Jul 2014

Question: 45 year old woman, presenting with confusion and auditory hallucinations. left internal carotid artery aneurysm clip 8 years ago (developed epilepsy after surgery). acute: Potassium 3.3 (L), gamma GT 119 (H), total protein 63 (L), Globulin 21 (L), Phosphate 1.68 (H), White cell count 12.3 (H), Lymphocytes 4.9 (H), Monocytes 1.4 (H), platelets 148 (L). Also: several falls, minor head tremor. no psych Hx
What is the possible diagnosis? how can the blood levels be explained? is there a correlation?
Thanks

Answered by Dr. Jyothi B L (1 hour later)

Brief Answer:
withdrawal with malnutrition

Detailed Answer:
Hi,
I am Dr. Jyothi BL and I would like to answer your query.
I went through the history and the laboratory values. My opinion is as as follows.

1. Looking at raised GGT, and other reduced values - my first probable diagnosis with psychiatric implication would be "alcohol withdrawal syndrome". Associated malnutrition and mild infection can explain the other levels

2. Blood levels can be explained based on malnutrition and moderate biliary damage, and asymptomatic infection.

3. If there is an history of alcohol intake, correlation is possible. Otherwise, medication history is required for possible overdose or interaction. Drug withdrawal should be ruled out importantly.

Hope it helps.
Any further query, happy to help again.
Dr. Jyothi BL

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Jyothi B L (1 hour later)

Thank you for your detailed answer. I am still a little puzzled with the presentation as the patient denies any alcohol consumption, only admits cannabis use occasionally.

She is taking the following medications:
Valproate 1200 per day
Oxycodone
Rosuvastatin
Metoprolol
Topiramate
aspirin
Oestradiol
Risperidone 10 mg per day (just started yesterday)
Benzos prn

CRP was normal

Would there be any organic caus explaining the picture of psychosis, epilepsy, blood level changes and reoccuring falls? I am thinking of Sklerodermia or progressive supranuclear palsy or similar?

Or is it just a accumulation of epilepsia, cerebelar vascular deficiency and epilepsy that causes psychosis and falls?

Thanks again for your answer.
cheers
Dr. Ube

Answered by Dr. Jyothi B L (10 hours later)

Brief Answer:
Rosuvastatin can cause GGT increase

Detailed Answer:
Hi Dr. Ube,
Thanks for your comments.

Going through the medication history, Rosuvastatin is one drug which can cause raised GGT levels in 2% of cases. Recently added risperidone can also cause in few cases.
However, the lab details does not explain the ongoing symptoms.

Falls could be secondary to vascular insufficiency maybe orthostatic hypotension, but I can't further comment due to my subject limitations.

If you require any further clarifications, do ask. If not, rate the answer and close the discussion.
Dr. Jyothi BL

Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Vaishalee Punj