Why would gilbert's syndrome not be diagnosis until middle age if genetic? no history of elevated bilirubin prior to 6 mos ago; other lfts were elevated, now ok.

Elevated bilirubin: Patients with gilberts syndrome have elevated unconjugated bilirubin which may not be high enough to cause clinical jaundice and there may be no other symptoms or signs till when it was diagnosed in your case, it can be asymptomatic and in most cases does not require any treatment.Insome patients it may show as jaundice and at that time blood test will show elevated bilirubin.

Dx of exclusion: Gilbert’s syndrome is due to deficiency of an enzyme that helps to excrete bilirubin. It is usually diagnosed between the ages of 15 and 30 years. Patients with gilbert’s syndrome are prone to develop jaundice from time to time. The risk increases with fasting, dehydration, repeated and profuse vomiting, infections, exertion and stress and after a surgery. If uncertain, specific tests can be done.