Joseph C. Yarze, MD; Santiago J. Munoz, MD; Lawrence S. Friedman, MD
To the Editors: In their review of Wilson disease, Stremmel and colleagues (1) suggest that normal ceruloplasmin levels may be found only in acute or fulminant liver involvement because ceruloplasmin is an acute-phase reactant. Elevation of the ceruloplasmin level into the normal range in Wilson disease, however, is most likely in patients with chronic active hepatitis or with a superimposed inflammatory or neoplastic disorder (2). Additionally, the ceruloplasmin level is elevated during pregnancy or estrogen use. In contrast, fulminant hepatic failure in any disease, including Wilson disease, may be associated with hypoceruloplasminemia caused by diminished hepatic synthetic capacity (3). Hypoceruloplasminemia
Yarze JC, Munoz SJ, Friedman LS. Diagnosing Wilson Disease. Ann Intern Med. ;117:91. doi: 10.7326/0003-4819-117-1-91_1
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Published: Ann Intern Med. 1992;117(1):91.
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