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There are other non-hepatic causes of chronic elevation of aminotransferases:

• Thyroid disorder
• Celiac disease
• Adrenal insufficiency

These entities should be considered if work up for liver causes is non-diagnostic.

Laboratory Investigation

• Thyroid stimulating hormone (TSH)
• Anti-endomysial antibody, tissue transglutaminase (for celiac sprue)
• Fasting cortisol level