Normal Bone Turnover in Transient Hyperphosphatasemia

Kutı́lek, Štěpán; Cervickova, Barbora; Bebova, Pavla; Kmonickova, Marie; Němec, Vladimír

doi:10.4274/jcrpe.680

Cited by 28 publications

(38 citation statements)

References 15 publications

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“…In the present study, we investigated the bone metabolism markers in patient 1 and found that all markers were normal. This is in line with other reports in which bone metabolism markers, such as serum calcium, phosphate, intact parathyroid hormone (PTH) and osteocalcin, were within the normal range during TH . Based on these facts, we did not investigate bone metabolism in the other patients of the present study.…”

Section: Discussionsupporting

confidence: 87%

Transient hyperphosphatasemia after pediatric liver transplantation

Yoshimaru

Matsuura

Hayashida

et al. 2016

Pediatrics International

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Section: Discussionsupporting

confidence: 87%

Transient hyperphosphatasemia after pediatric liver transplantation

Yoshimaru

Matsuura

Hayashida

et al. 2016

Pediatrics International

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“…The pathological origin of the ALP fraction detected in TH is unclear, but Kutilek et al recently reported that the increased ALP activity in TH is not likely from the increased bone turnover. 6 Furthermore, the resistance to heat treatment of the ALP isoenzyme fraction of TH is greater than that of a normal bone fraction. 5 Taking this into account, we speculate that the fraction may be of liver origin.…”

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confidence: 99%

Benign transient hyperphosphatasemia associated with Epstein–Barr virus infection

Koike

Aoki

2013

Pediatrics International

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Elevated serum alkaline phosphatase (ALP) is sometimes observed in children during routine blood chemistry analysis or in patients with various illnesses, and returns to normal within several months. This condition is known as benign transient hyperphosphatasemia (TH). 1-3 TH is considered to be present when serum ALP is >1000 IU/L; 1 furthermore, the elevation is often accompanied by elevation of both liver and bone ALP isoenzymes. 4,5 We report the case of an infant with Epstein-Barr virus (EBV)-associated TH (EBVATH).A male infant was found to have hepatomegaly at his routine health check-up at 18 months of age, and was referred to hospital by his physician. On physical examination, he was in good general condition, but the liver was palpable 5 cm below the right costal margin, and the spleen was enlarged to 3 cm below the left costal margin. Laboratory findings were as follows: white blood cell count, 9900/μL; aspartate aminotransferase, 49 IU/L; alanine aminotransferase, 22 IU/L; lactate dehydrogenase, 359 IU/L; ALP, 3697 IU/L; glucose, 94 mg/dL; calcium, 10.0 mg/dL; phosphorus, 5.3 mg/dL; ferritin, 5.8 ng/mL; neuron-specific enolase, 23 ng/mL; EBV-specific antibody testing including viral capsid antigen (VCA)-IgG and -IgM, and EBV nuclear antigen (EBNA), were all negative. Serum ALP isoenzymes measured on agarose electrophoresis (Bio Medical Laboratories, Tokyo, Japan) had a slightly diffuse pattern with bimodal peaks between Fig. 1 Serum alkaline phosphatase (ALP) isoenzyme patterns in children with hyperphosphatasemia. (a) Present case: bimodal peaks between ALP 2 and 3 indicate benign transient hyperphosphatasemia. (b) Fourteen-month-old boy with serum ALP = 1319 IU/L: a single peak between 2 and 3 indicates normal bone growth in a healthy infant. (c) Seven-year-old girl with serum ALP = 1007 IU/L and Epstein-Barr virus infection: liver dysfunction with cholestasis. Serum ALP isoenzymes were measured on agarose electrophoresis (Bio Medical

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“…Many case reports [4,6,7,8] and retrospective reviews of patient series [2,9,10,11,12] have been published. Few prospective studies with data on the prevalence of TH in healthy children exist.…”

Section: Introductionmentioning

confidence: 99%

“…Other studies have used factors in relation to the upper limit of a reference range, e.g. >3 or 5 times the upper limit for adults [8,15]. …”

Section: Introductionmentioning

confidence: 99%

Alkaline Phosphatase in Healthy Children: Reference Intervals and Prevalence of Elevated Levels

Ridefelt¹,

Gustafsson

Aldrimer

et al. 2014

Horm Res Paediatr

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Background: Transient hyperphosphatasemia (TH) is an often unnoticed benign entity, primarily affecting children below 5 years of age. However, the prevalence among healthy children is unknown. We used data from a Swedish pediatric reference interval project to estimate the prevalence of high alkaline phosphatase (ALP) among healthy children and to calculate pediatric reference intervals. Methods: Blood was collected from 699 subjectively healthy children aged 6 months to 18 years. After exclusion of subjects with high ALP, age- and gender-specific reference intervals were calculated. Results: Six children had ALP levels >16.7 µkat/l (>1,000 U/l), including 4 females and 2 males aged 7-22 months. The prevalence in the age group from 6 months to 2 years was 6.2% (6/97). None of the older children had levels of ALP >16.7 µkat/l. The study did not include the follow-up of these apparently healthy children. Consequently, conditions others than TH explaining the elevated ALP could not be excluded. However, general chemistry analyses, such as liver enzymes, calcium, intact PTH and vitamin D, were essentially normal in these children. Conclusions: The prevalence of high ALP among subjectively healthy children was approximately 2.4% below 5 years of age and 6.2% below 2 years. Reference intervals vary with age and gender.

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Normal Bone Turnover in Transient Hyperphosphatasemia

Cited by 28 publications

References 15 publications

Transient hyperphosphatasemia after pediatric liver transplantation

Transient hyperphosphatasemia after pediatric liver transplantation

Benign transient hyperphosphatasemia associated with Epstein–Barr virus infection

Alkaline Phosphatase in Healthy Children: Reference Intervals and Prevalence of Elevated Levels

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