Supplementary Material for: Case Report: Elevated aminotransferases and altered hepatic perfusion due to retroperitoneal paraganglioma

Introduction: Hepatocellular injury is characterized by elevated levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). In contrast, alkaline phosphatase levels are usually elevated in cholestatic diseases. Due to the multiples causes, it is crucial to define the etiology for proper management. The most common diagnoses are viral hepatitis, autoimmune hepatitis, Wilson's disease, Drug-Induced Liver Injury (DILI), acute alcoholic hepatitis, and ischemic hepatitis. Extrahepatic causes such as endocrine and cardiovascular conditions should also be considered. Case Presentation: A 46-year-old male presented with a two-month history of elevated transaminase levels that progressed to jaundice and dark urine (choluria) in the preceding 30 days. During the investigation, it was discovered that the hepatocellular injury was caused by hypoperfusion secondary to a retroperitoneal catecholamine-secreting sympathetic paraganglioma, in which the patient achieved a favorable outcome with complete preservation of liver function. Conclusions: This case highlights the importance of considering rare causes of hepatocellular injury.

引言：肝细胞损伤以天冬氨酸氨基转移酶（aspartate aminotransferase, AST）和丙氨酸氨基转移酶（alanine aminotransferase, ALT）水平升高为特征。与之相对，碱性磷酸酶水平升高通常见于胆汁淤积性疾病。由于致病诱因多样，明确病因以实施恰当诊疗至关重要。最常见的诊断包括病毒性肝炎、自身免疫性肝炎、威尔逊病、药物性肝损伤（Drug-Induced Liver Injury, DILI）、急性酒精性肝炎及缺血性肝炎。同时需考虑内分泌疾病、心血管疾病等肝外病因。
病例报告：1例46岁男性患者，既往有2个月的转氨酶升高病史，近30天病情进展为黄疸及深色胆红素尿（choluria）。调查过程中发现，该患者的肝细胞损伤由腹膜后分泌儿茶酚胺的交感神经副神经节瘤继发的低灌注所致，经治疗后患者预后良好，肝功能完全恢复正常。
结论：本案例凸显了重视肝细胞损伤罕见病因排查的临床必要性。