Case Report: Elevated Aminotransferases and Altered Hepatic Perfusion due to Retroperitoneal Paraganglioma.

Introduction: Hepatocellular injury is characterized by elevated levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). In contrast, alkaline phosphatase levels are usually elevated in cholestatic diseases. Due to the multiples causes, it is crucial to define the etiology for proper management. The most common diagnoses are viral hepatitis, autoimmune hepatitis, Wilson's disease, drug-induced liver injury, acute alcoholic hepatitis, and ischemic hepatitis. Extrahepatic causes such as endocrine and cardiovascular conditions should also be considered. Case Presentation: A 46-year-old male presented with a 2-month history of elevated transaminase levels that progressed to jaundice and dark urine (choluria) in the preceding 30 days. During the investigation, it was discovered that the hepatocellular injury was caused by hypoperfusion secondary to a retroperitoneal catecholamine-secreting sympathetic paraganglioma, in which the patient achieved a favorable outcome with complete preservation of liver function. Conclusions: This case highlights the importance of considering rare causes of hepatocellular injury.