History and exam
Key diagnostic factors
common
postpubertal age
Rarely diagnosed before puberty. During puberty, there are alterations in sex steroids leading to higher levels of bilirubin.[16]
positive family history of GS
GS is most likely transmitted in an autosomal recessive pattern. However, inheritance patterns of GS have been difficult to ascertain. Data suggest an autosomal recessive pattern of inheritance, whereas earlier studies report a possible autosomal dominant transmission with incomplete penetrance.[12]
icterus (jaundice)
The hallmark of GS is icterus (jaundice), especially when under physical or psychological stress. The cause of hyperbilirubinemia under stress is not entirely understood, though several hypotheses have been presented including increased heme turnover, increased enterohepatic uptake of unconjugated bilirubin, and altered hepatic uptake mechanisms.[24][25][26]
absence of hepatosplenomegaly
GS can be diagnosed if other disease processes can be excluded.
no stigmata of chronic liver disease
GS can be diagnosed if other disease processes can be excluded.
Risk factors
strong
postpubertal age
GS is rarely diagnosed before puberty. During puberty, there are alterations in sex steroids leading to higher levels of bilirubin. Testosterone decreases the activity of uridine-diphosphoglucuronate glucuronosyltransferase (UDPGT), and female sex hormones exert the opposite effect, explaining the sex ratio in GS and the postpubertal diagnosis.[16]
weak
family history of GS
GS is most likely inherited in an autosomal recessive manner; therefore, first-degree family members are at risk. However, inheritance patterns of GS have been difficult to ascertain. Data suggest an autosomal recessive pattern of inheritance, whereas earlier studies report a possible autosomal dominant transmission with incomplete penetrance.[12]
type 1 diabetes mellitus
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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