TABLE 1.

Etiology of elevated alpha-fetoprotein level ^a

Hepatic causes of AFP elevation		Nonhepatic causes of AFP elevation
Neoplastic	Non-neoplastic	Neoplastic	Non-neoplastic
Hepatocellular carcinoma	Cirrhosis	Germ cell tumors (testicular and ovarian)	Normal pregnancy/infancy
Intrahepatic cholangiocarcinoma	Fulminant acute hepatitis	Gastric cancer	Colitis
Liver metastasis	Viral hepatitis		Sepsis
	Metabolic dysfunction–associated steatotic liver disease		Fetal disorders (gastroschisis, neural tube defect)
	Biliary obstruction (intrahepatic and extrahepatic)		Hereditary tyrosinemia type 1
	Drug-induced liver injury		Hereditary AFP persistence
	Alcohol liver disease		Beckwith-Wiedemann syndrome
	Hepatic inflammatory pseudotumor		Systemic lupus erythematosus
	Neonatal hepatitis		Hirschsprung disease
	Massive hepatic necrosis		Ataxia telangiectasia
	Autoimmune hepatitis
	Wilson disease
	Hemochromatosis

^aModified from Hanif et al. ⁵⁸

Abbreviation: AFP, alpha-fetoprotein.