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7-alpha-hydroxy-4-cholesten-3-one
(a.k.a 7αC4)
minimum sample volume required ~ 5ml
Tube type: SST
Special instructions
Fasting sample must be collected 08:00 - 10:00am.
Sent away
to Wythenshawe Hospital, Manchester
Reference range
<50: Bile Acid Diarrhoea unlikely, 50 - 142: Equivocal, >142: Bile Acid Diarrhoea likely
Units
nmol/L
Turnaround Time
14
days
Department: Biochemistry
Clinical Application
The serum marker, 7-alpha-hydroxy-4-cholesten-3-one (7αC4) is an intermediary product in the liver synthesis of bile acids, cholic acid and chenodeoxycholic acid. Fasting 7αC4 levels provide a measure of bile acid production and is recommended as a non-invasive, cost-effective, convenient screen for Bile Acid Diarrhoea (BAD).
Fasting 7αC4 can be used as an alternative to the gold standard nuclear medicine 75Se-homocholic acid-taurine (75SeHCAT) scan, which requires patients to ingest 75SeHCAT and attend for 2 full body gamma scans 7 days apart to determine retention of the isotope, with low percentage retention being a sensitive and specific test for BAD. 7αC4 levels are inversely correlated to 75SeHCAT retention.
Limitations
False negative results can be caused by statins (advise stop for 5 days prior to sample collection) or liver disease (do not perform in patients with advanced liver disease/cirrhosis).
False positive results can be due to measurement in non-fasted samples (collect serum following 12h overnight fast), samples taken after 10am (7αC4 increases due to diurnal variation), alcohol (suggest abstain for 24h prior to testing), bile acid sequestrants (ideally test 7αC4 before trialling treatment (otherwise stop for 24h)) and hypertriglyceridaemia.
Webpage created: September 2026.
