Which condition is associated with elevated indirect/unconjugated bilirubin levels?

Gilbert syndrome is a genetic condition characterized by the impaired uptake and conjugation of bilirubin in the liver. Individuals with Gilbert syndrome often have episodes of elevated levels of unconjugated (indirect) bilirubin, which can be triggered by factors such as fasting, dehydration, or stress. The liver's ability to process bilirubin is not significantly hindered; rather, the enzyme responsible for conjugating bilirubin is less active in affected individuals, leading to the accumulation of unconjugated bilirubin in the bloodstream.

In contrast, Dubin-Johnson syndrome and Rotor syndrome involve the conjugated form of bilirubin and present with elevated direct (conjugated) bilirubin levels due to defects in the excretion of bilirubin from the hepatocytes. Cholestasis also leads to an increase in conjugated bilirubin due to impaired bile flow, further distinguishing it from Gilbert syndrome. Gilbert syndrome is typically harmless and often does not require treatment, whereas other conditions associated with elevated bilirubin may indicate underlying liver dysfunction or pathology.