Melike ARSLAN
Türkiye Çocuk Hastalıkları Dergisi - 2026;20(1):52-57
Objective: This study aimed to investigate the etiology of hypertransaminasemia in children and to evaluate the clinical characteristics of patients based on age and underlying causes. Material and Methods: A total of 210 pediatric patients aged between 1 month and 18 years who presented to the Pediatric Gastroenterology Outpatient Clinic with hypertransaminasemia were retrospectively analyzed. Hypertransaminasemia was defined as AST >50 IU/L and ALT >45 IU/L on at least two separate occasions within two months. Results: The mean age of the patients was 5.36+/-5.30 years and 50.5% were female. At presentation, 30.5% were asymptomatic, with fever being the most common symptom (23.4%). Physical examination findings were normal in 53.8% of cases. Mean AST and ALT values were significantly higher in symptomatic patients compared to asymptomatic ones (p<0.001). No significant difference were observed between age groups in terms of mean ALT and AST values (p=0.290, p=0.190). Hypertransaminasemia was mild in 55.7% of patients, moderate in 20.5%, and severe in 23.8%. An underlying etiology was identified in 61% of cases. The most common cause was infectious diseases, followed by metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic/genetic disorders. Severe hypertransaminasemia was significantly more frequent in infectious diseases than in idiopathic cases or MASLD, whereas mild hypertransaminasemia was more common in MASLD and idiopathic cases compared to infections (p<0.001). Conclusion: Infectious diseases and MASLD remain the leading causes of hypertransaminasemia in children. Infectious etiologies contribute across all age groups, MASLD is strongly linked to obesity and adolescence. As elevated transaminase levels may be the only clinical clue, especially in asymptomatic patients with normal physical examinations, careful follow-up and comprehensive evaluation are essential to avoid potential complications.
