Diagnosis of Wilson Disease Slit-lamp examination for Kayser-Fleischer rings Serum ceruloplasmin, sometimes serum copper, and 24-hour urinary copper excretion Sometimes confirmation by penicillamine provocation test or liver biopsy Wilson disease should be suspected in people < 40 with any of the following: An unexplained hepatic, neurologic, or psychiatric disorder An unexplained persistent elevation in hepatic transaminases A sibling, parent, or cousin with Wilson disease Fulminant hepatitis If Wilson disease is suspected, slit-lamp examination for Kayser-Fleischer rings is required, and serum ceruloplasmin levels and 24-hour urinary copper excretion are measured.