Anastrozole induced irreversible hepatotoxicity: Frailty and adverse drug reactions

Laboratory tests showed severe cholestasis: alanine transaminase 33 U/l, alkaline Phosphatase 614 U/l, bilirubin 317 μmol/L, gamma glutamyl transferase 468 U/l, ammonia 90 μmol/L (normal value: <50). CT scan of abdomen confirmed no evidence of hepatic metastases or extra and intrahepatic biliary ductal dilatation. Anastrozole was then discontinued. During the admission, serum alkaline phosphatase and bilirubin continued to worsen despite normal transaminases.