Persistent hypertransaminasemia in asymptomatic children: A stepwise approach

Table 3 Fatty liver disease; possible causes in likely asymptomatic children and adolescents

General or systemic	Genetic-metabolic causes	Drugs/chemicals
Obesity	Cystic fibrosis	Ethanol
Metabolic syndrome	Shwachman syndrome	Ecstasy, cocaine, solvents
Obstructive sleep apnea	Wilson’s disease	Nifedipine
Polycystic ovary syndrome	Alpha 1-antitrypsin deficiency	Diltiazem
Diabetes mellitus type 1	Fructosemia	Estrogens
Thyroid disorders	Cholesterol ester storage disease	Corticosteroids
Hypothalamic-pituitary disorders	Glycogen storage disease (type I, VI and IX)	Methotrexate
Inflammatory bowel disease	Mitochondrial and peroxisomal defects	Prednisolone
Celiac disease	α- and β-oxidation defects	Valproate
Protein calorie malnutrition	Organic acidosis	Vitamin
Rapid weight loss	Abeta or hypobetalipoproteinemia	Zidovudine and HIV treatments
Anorexia nervosa	Porphyria cutanea tarda	Solvents
Small intestinal bacterial overgrowth	Homocystinuria	Pesticides
Hepatitis C	Familial hyperlipoproteinemias
	Bile acids synthesis defects
	Congenital disorders of glycosylation
	Citrin deficiency
	Turner syndrome

Modified from the references of 30 and 38. HIV: Human immunodeficiency virus.