Your liver breaks down nutrients and filters toxins out of your body, which it does with the help of enzymes. Transaminitis, sometimes called hypertransaminasemia, refers to having high levels of certain liver enzymes called transaminases. When you have too many enzymes in your liver, they start to move into your blood stream. Alanine transaminase (ALT) and aspartate transaminase (AST) are the two most common transaminases involved in transaminitis.

Most people with transaminitis don’t know they have it until they do a liver function test. Transaminitis itself doesn’t produce any symptoms, but it usually indicates that there’s something else going on, so doctors use it as a diagnostic tool. Some people also have temporarily high levels of liver enzymes without any underlying cause. However, because transaminitis can by a symptom of serious conditions, such as liver disease or hepatitis, it’s important to rule out any potential causes.

Fatty liver disease

Your liver naturally contains some fat, but too much of it can lead to fatty liver disease. It’s usually associated with drinking large amounts of alcohol, but nonalcoholic fatty liver disease is becoming more common. No one’s sure exactly what causes nonalcoholic fatty liver disease, but common risk factors include:

Fatty liver disease usually doesn’t cause any symptoms, and most people don’t know they have it until they get a blood test. However, some people have fatigue, mild abdominal pain, or an enlarged liver that your doctor can feel during a physical exam. Treating fatty liver disease often involves lifestyle changes, such as avoiding alcohol, maintaining a healthy weight, and eating a balanced diet.

Viral hepatitis

Hepatitis refers to inflammation of the liver. There are several types of hepatitis, but the most common one is viral hepatitis. The most common types of viral hepatitis that cause transaminitis are hepatitis B and hepatitis C.

Hepatitis B and C share the same symptoms, which include:

  • yellow-tinted skin and eyes, called jaundice
  • dark urine
  • nausea and vomiting
  • fatigue
  • abdominal pain or discomfort
  • joint and muscle pain
  • fever
  • loss of appetite

Talk to your doctor if you have any symptoms of viral hepatitis. If left untreated, it can cause permanent liver damage, especially if you have hepatitis C.

Medications, supplements, and herbs

In addition to helping your body process food, your liver also breaks down anything else you take by mouth, including medications, supplements, and herbs. Sometimes these can cause transaminitis, especially when they’re taken in high doses.

Medications that can cause transaminitis include:

  • over-the-counter pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
  • statins, such as atorvastatin (Lipitor) and lovastatin (Mevacor, Altocor)
  • cardiovascular medications, such as amiodarone (Cordarone) and hydralazine (Apresoline)
  • cyclic antidepressants, such as desipramine (Norpramin) and Imipramine (Tofranil)

Supplements that may cause transaminitis include:

Common herbs that may cause transaminitis include:

  • chaparral
  • kava
  • senna
  • skullcap
  • ephedra

If you take any of these, tell your doctor about any unusual symptoms you have. You may also want to have your blood tested regularly to make sure they’re not affecting your liver. If they are, you likely just need to lower the amount you take.

HELLP syndrome

HELLP syndrome is a serious condition that affects 5–8 percent of pregnancies. It refers to a group of symptoms that include:

  • Hemolysis
  • EL: elevated liver enzymes
  • LP: low platelet count

It’s often associated with preeclampsia, which causes high blood pressure in pregnant women. HELLP syndrome can cause liver damage, bleeding problems, and even death if it’s not properly managed.

Additional symptoms of HELLP syndrome include:

  • fatigue
  • stomach pain
  • nausea and vomiting
  • abdominal pain
  • shoulder pain
  • pain when breathing deeply
  • bleeding
  • swelling
  • changes in vision

If you’re pregnant and start to notice any of these symptoms, contact your doctor as soon as possible.

Genetic diseases

Several inherited diseases can cause transaminitis. They’re usually conditions that affect your body’s metabolic processes.

Genetic diseases that can cause transaminitis include:

Nonviral hepatitis

Autoimmune hepatitis and alcoholic hepatitis are two common types of nonviral hepatitis that can cause transaminitis. Nonviral hepatitis produces the same symptoms as viral hepatitis.

Autoimmune hepatitis happens when your immune system attacks cells in your liver. Researchers aren’t sure what causes this, but genetic and environmental factors seem to play a role.

Alcoholic hepatitis results from drinking a lot of alcohol, usually over the course of many years. If you have alcoholic hepatitis, you must stop drinking alcohol. Not doing so can lead to serious complications, including death.

Viral infections

The most common viral infections that cause transaminitis are infectious mononucleosis and cytomegalovirus (CMV) infection.

Infectious mononucleosis is spread through saliva and may cause:

  • swollen tonsils and lymph nodes
  • sore throat
  • fever
  • swollen spleen
  • headaches
  • fever

CMV infection is very common and can be spread through several body fluids, including saliva, blood, urine, semen, and breast milk. Most people don’t experience any symptoms unless they have a weakened immune system. When CMV infection does cause symptoms, they’re usually similar to those of infectious mononucleosis.

A variety of things, from serious diseases to simple medication changes, can cause elevated liver enzymes, known as transaminitis. It’s also not unusual for some people to temporarily have increased liver enzymes. If a blood test shows that you have transaminitis, it’s important to work with your doctor to rule out any possible underlying causes because many of them can lead to serious liver damage and even liver failure if left untreated.