What are the key clinical features that differentiate Gilbert's Syndrome from other causes of hyperbilirubinemia?

The key clinical features that differentiate Gilbert's syndrome from other causes of hyperbilirubinemia primarily revolve around its benign nature and the overall well-being of the affected individual ¹,².

• Gilbert's Syndrome: People with Gilbert's syndrome are generally well, and the condition does not require treatment or regular monitoring ¹,². It cannot progress or cause chronic liver disease ¹. Episodes of jaundice are typically self-limiting, resolving within a few days, and are not a sign of serious illness or infection ¹. These episodes may be triggered by physical or psychological stress, such as dieting, fasting, surgery, dehydration, alcohol ingestion, infectious illness, heavy physical exertion, or lack of sleep ¹. Gilbert's syndrome can be diagnosed and managed in primary care, and individuals should be fully reassured ². However, if an episode of jaundice is more severe or persistent than usual, medical advice should be sought as it may indicate an alternative diagnosis ¹.
• Other Causes of Hyperbilirubinemia: In contrast, most other causes of jaundice in adults are usually indicative of a serious underlying condition, such as malignancy, and generally necessitate prompt admission or referral to secondary care ². Urgent same-day secondary care assessment is required if a person with jaundice exhibits red flag signs and symptoms, has a bilirubin level greater than 100 micromol/L, an abnormal clotting profile, abnormal renal function, or is frail or has significant co-morbidities ². All people with unexplained jaundice should be referred immediately ². While Hepatitis A can be managed in primary care if the person is well and the diagnosis is serologically confirmed, acutely unwell individuals with Hepatitis A should be admitted ². Jaundice in newborn babies under 28 days is assessed differently, with specific bilirubin thresholds guiding the need for interventions like phototherapy or exchange transfusion, and investigations are conducted to rule out underlying diseases, particularly if conjugated bilirubin levels are elevated (e.g., greater than 25 micromol/litre) ³.