Case history
Case history
A 21-year-old male college student presents with icterus (jaundice). He noticed this after a brief episode of sleep deprivation, having studied all night the previous week for an exam. He denies abdominal pain, nausea, vomiting, fatigue, or pruritus. There have been no previous episodes of jaundice. There is no known family history of liver disease. He otherwise feels well. He does not smoke, and drinks 3 to 5 alcoholic beverages at the weekends. He takes no medications and has no known medical allergies. He denies any unwell contacts. His examination is normal without hepatosplenomegaly or stigmata of chronic liver disease.
Other presentations
Up to 30% of patients will be asymptomatic at the time of diagnosis.[1] An elevated bilirubin level may be found during work-up for an unrelated condition, such as a preoperative evaluation, or as part of routine health screening. The predominating bilirubin fraction is unconjugated (indirect) bilirubin. Otherwise, symptoms are usually non-specific and unrelated to bilirubin levels. Presenting complaints occasionally include abdominal pain, fatigue, and malaise. Patients with GS might have decreased health-related quality of life during jaundice episodes.[2] Between 5% and 7% of patients may present with mild elevations of liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]). Patients might present with haemolysis, as other causes of unconjugated hyperbilirubinaemia (in particular, hereditary spherocytosis and thalassaemia) can co-exist with GS.[3][4] GS is more frequent in patients with type 1 diabetes, with a 3-fold higher occurrence than in a healthy control group.[5]
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