Abstract
Stauffer's syndrome represents a rare cause of abnormal liver biochemistries. We report a patient who presented with abnormal aminotransferase values and after a comprehensive evaluation was diagnosed with renal cell carcinoma (RCC) as the probable underlying cause. Case: An otherwise healthy and asymptomatic 53-year-old female with no significant past medical history was referred to hepatology for evaluation of persistently abnormal liver tests. There was no personal or family history of liver disease, her weight was stable, she had taken no new medications, she did not consume alcohol or herbal preparations and her viral hepatitis serologies and autoantibodies were negative. Physical examination was normal. Laboratory tests showed mild elevation of liver enzymes that had only been noted for the last year, and were previously normal, with a peak alanine aminotransferase (ALT) of 106 IU/L and peak aspartate aminotransferase (AST) of 60 IU/L. An abdominal ultrasound was obtained that showed diffuse echogenicity most likely consistent with diffuse hepatic fatty infiltration and incidentally revealed a 12 cm enhancing mass arising from the lower pole of the left kidney suspicious for RCC. She subsequently underwent successful nephrectomy with pathology demonstrating a chromophobe variant of RCC. No hepatic metastasis or main bile duct obstruction were detected by abdominal computed tomography. Her liver function test abnormalities normalized one month post-operatively. Discussion: Stauffer's syndrome was reported in 1961 as “nephrogenic hepatomegaly” and is characterized by elevated liver function tests in the absence of metastatic disease, raised erythrocyte sedimentation rate, and occasionally jaundice. Prolongation of the prothrombin time and hepatosplenomegaly may also be seen. An important differential diagnosis is liver metastasis as an underlying etiology. Malignant diseases may cause jaundice through either main bile duct obstruction or widespread metastasis to the liver. RCC causes various paraneoplastic manifestations, which can be the main presenting symptoms. Hepatic dysfunction, in absence of liver metastases, occurs in 10 to 15% of patients with RCC, attributed to the production of cytokines from the tumor cells, including interleukin-6. Conclusion: Stauffer's syndrome is a rare paraneoplastic manifestation of RCC. We present variant case of probable Stauffer's syndrome with resolution of otherwise unexplained liver biochemistries after the patient underwent nephrectomy to resect a chromophobe RCC. The case also highlights the benefits of abdominal ultrasound early in the course of routine evaluation of abnormal LFTs.Figure 1
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have