Serum
glycocholic acid (SGC) was measured by radioimmunoassay in 277 samples from 122 children with
hepatobiliary disorders and from 23 healthy age-matched controls. In patients with
hepatobiliary disease the SGC was more frequently abnormal (83%) than values for
serum albumin (7%), prothrombin time (17%),
bilirubin (22%),
alkaline phosphatase (45%),
aspartate transaminase (57%) and gammaglutamyl
transpeptidase (63%). The cumulative frequency of abnormality of these six tests was equal to that of SGC alone. Serum
glycocholic acid concentrations were raised in 13 patients in whom all other tests of liver function were normal. Two of these had clinical and histological evidence of
liver disease, while four had biopsy-proven hepatic
fibrosis or
cirrhosis, and two of three with
chronic active hepatitis in remission subsequently relapsed. Four patients have as yet, no other clinical or biochemical evidence of continuing
liver disease. Serum
glycocholic acid was normal in seven children with abnormal
aspartate transaminase or gammaglutamyl
transpeptidase in whom there is strong suspicion of significant hepatic disease. A wide range of values of SGC was found with marked overlap between the values found in the different disease entities studied. The SGC value was related to the serum concentration of
aspartate transaminase and gammaglutamyl
transpeptidase but not to other tests of liver function. Serum
glycocholic acid concentration was considered in relation to the severity of histological abnormality in 25 percutaneous liver biopsies. The extent of the rise in SGC was related to the presence or degree of histological severity of oedema in the portal tracts, disruption of the limiting plate, parenchymal
fibrosis and hepatocellular
necrosis but not to other histological features. The very high incidence of abnormal SGC values found in this study does suggest that in an ordinary inpatient and
outpatient service SGC determination is a practical and sensitive
indicator of the presence of significant
liver disease but for its comprehensive identification
aspartate transaminase and gammaglutamyl
transpeptidase must also be determined.