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Gilbert Syndrome — RACP Adult Medicine MCQ

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ModerateGastroenterologyGilbert SyndromeRACP Adult Medicine

A 20-year-old man presents with intermittent unconjugated hyperbilirubinaemia (bilirubin 55 μmol/L, unconjugated 50 μmol/L) triggered by fasting and illness. Transaminases, ALP, GGT, FBE, reticulocytes, and haptoglobin are all normal. LDH is normal. What is the most likely LFT pattern?

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Correct answer: E — Isolated unconjugated hyperbilirubinaemia

Isolated unconjugated hyperbilirubinaemia with normal liver enzymes, normal haemolysis markers (LDH, haptoglobin, reticulocytes), and normal FBE in a young man triggered by fasting is Gilbert syndrome. It affects ~5% of the population. No treatment is required. It is important to exclude haemolysis (which also causes unconjugated hyperbilirubinaemia but with elevated LDH/reticulocytes).

Reference: eTG Gastrointestinal – 2024 – Unconjugated Hyperbilirubinaemia