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（AST）与丙氨酸氨基转移酶（ALT）水平升高为典型特征。与之相反，碱性磷酸酶水平升高通常见于胆汁淤积性疾病。由于病因多样，明确病因对于制定合理的诊疗方案至关重要。临床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（DILI）、急性酒精性肝炎及缺血性肝炎。同时亦需考虑内分泌与心血管疾病等肝外病因。病例报告：一名46岁男性患者，自述两个月来转氨酶水平升高，近30天病情进展为黄疸及胆汁尿（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，患者最终获得良好预后，肝功能完全保留。结论：本案例凸显了排查肝细胞损伤罕见病因的重要性。