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Michael J. Hodgson, MD, MPH
Farmington, Conn

Arch Intern Med. 1992;152(1):208.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor. —

The thoughtful review by Sherman¹ provides a useful approach to the practicing physician. He makes the recommendation that elevations of alanine aminotransferase levels less than twofold not be pursued even if they persist for 6 weeks or more. Although this appears a useful strategy in general, some forms of liver disease may benefit from a slightly different approach. He fails to include environmental and occupational exposures in his list of potential causes. This is a common omission; several recent reviews^2-4 of fatty liver disease have similarly failed to suggest hepatotoxin exposure as a potential cause of elevated alanine aminotransferase levels in practice. Outbreaks of occupational liver disease are, nevertheless, well described.^5,6,6 A case-control study⁷ of randomly occurring fatty liver disease has similarly suggested that hepatotoxin exposure may be an important risk factor. Four further cases with less than twofold elevations of alanine . . . [Full Text PDF of this Article]

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