Atorvastatin associated with gamma glutamyl transpeptidase elevation in a hyperlipidemia patient: A case report and literature review

Medicine (Baltimore). 2020 Oct 2;99(40):e22572. doi: 10.1097/MD.0000000000022572.


Rationale: Atorvastatin is the most common drug used in therapy for cardiovascular diseases. The most common adverse side effects associated with statins are myopathy and hypertransaminasemia. Here, we report a rare case of gamma glutamyl transpeptidase (GGT) elevation induced by atorvastatin.

Patient concerns: A 47-year-old male was admitted to our hospital with dyslipidemia, he had been taking pitavastatin 2 mg/day for 2 months. The levels of total cholesterol (265.28 mg/dL) and low-density lipoprotein-cholesterol (LDL) (179.15 mg/dL) were also high.

Diagnosis: Blood lipid test showed mixed dyslipidemia.

Intervention: Atorvastatin 10 mg/day was given to the patient.

Outcomes: The patient came back to our hospital for blood tests after 4 weeks. Although no symptoms were detectable, the patient's GGT level was markedly elevated (up to 6-fold over normal level) with less marked increases in alkaline phosphatase (ALP) and alanine aminotransferase (ALT). The serum GGT level returned to normal within 6 weeks of cessation of atorvastatin.

Lessons: This is a case of GGT elevation without hyperbilirubinemia, hypertransaminasemiam, or serum creatine phosphokinase (CPK) abnormalities despite an atorvastatin regimen. This case highlights GGT elevation caused by atorvastatin, a rare but serious condition. Clinicians should be aware of these possible adverse effects and monitor liver function tests in patients on statin therapy.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Alanine Transaminase / blood
  • Alkaline Phosphatase / blood
  • Atorvastatin / administration & dosage
  • Atorvastatin / adverse effects*
  • Atorvastatin / therapeutic use
  • Cardiovascular Diseases / drug therapy
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Dyslipidemias / diagnosis
  • Dyslipidemias / drug therapy*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Lipids / blood
  • Male
  • Middle Aged
  • Quinolines / administration & dosage
  • Quinolines / adverse effects*
  • Quinolines / therapeutic use
  • Withholding Treatment
  • gamma-Glutamyltransferase / blood
  • gamma-Glutamyltransferase / drug effects*


  • Cholesterol, HDL
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Lipids
  • Quinolines
  • Atorvastatin
  • gamma-Glutamyltransferase
  • Alanine Transaminase
  • Alkaline Phosphatase
  • pitavastatin