A deficiency in the
bilirubin specific form of glucuronosyltransferase is thought to be the cause of
Gilbert's syndrome, which is characterized by
unconjugated hyperbilirubinemia. It is also associated with
Crigler–Najjar syndrome, a more serious disorder where the enzyme's activity is either completely absent (Crigler–Najjar syndrome type I) or less than 10% of normal (type II). Infants may have a developmental deficiency in UDP-glucuronyl transferase, and are unable to hepatically metabolize the antibiotic drug
chloramphenicol which requires glucuronidation. This leads to a condition known as
gray baby syndrome.
Causes Causes of unconjugated hyperbilirubinemia are divided into three main categories, namely, excessive
bilirubin synthesis, liver bilirubin uptake malfunction, and bilirubin conjugation compromise. As to excessive bilirubin synthesis, both
intravascular hemolysis and
extravascular hemolysis can involve in the pathophysiology. Additionally,
dyserythropoiesis and extravasation of
blood into tissues such as
angioedema and
edema can also lead to indirect hyperbilirubinemia, along with
heart failure,
medication-induced,
ethinyl estradiol,
chronic hepatitis, and
cirrhosis that are, otherwise, attributed to hepatic bilirubin mal-uptake and bilirubin conjugation compromise, respectively. ==Genes==