The elevated serum alkaline phosphatase--the chase that led to two endocrinopathies and one possible unifying diagnosis

Abstract

A 39-year-old Chinese man with hypertension being evaluated for elevated serum alkaline phosphatase (SAP) levels was found to have an incidental right adrenal mass. The radiological features were characteristic of a large adrenal myelolipoma. This mass was resected and the diagnosis confirmed pathologically. His blood pressure normalised after removal of the myelolipoma, suggesting that the frequently observed association between myelolipomas and hypertension may not be entirely coincidental. Persistent elevation of the SAP levels and the discovery of hypercalcaemia after surgery led to further investigations which confirmed primary hyperparathyroidism due to a parathyroid adenoma. The patient's serum biochemistry normalised after removal of the adenoma.The association of adrenal myelolipoma with primary hyperparathyroidism has been reported in the literature only once previously. Although unconfirmed by genetic studies this association may possibly represent an unusual variation of the multiple endocrine neoplasia type 1 syndrome.

Characterizing the Fallback Pig

“…Not only were activities greater in LWW than HWW pigs, but they were substantially greater than expected for pigs of this age (343 to 394 U/L vs. expected 41 to 176 U/L; 10). In dogs, elevated serum alkaline phosphatase concentrations have been linked to hypothyroidism (27), but this was not supported by T3 or T4 concentrations in this experiment. However, high alkaline phosphatase activities have also been linked to increased circulating endotoxin concentrations (28).…”

Incidentally discovered adrenal myelolipoma associated with hyperthyroidism

“…8 Extra-adrenal endocrine dysfunction has been reported with myelolipoma, including rare cases of pituitary Cushing's disease, adrenogenital syndrome associated with an interstitial tumor of the testis, hyperparathyroidism, and hyperthyroidism. 2,3,9,10 To the best of our knowledge, our patient is the fourth reported case of a myelolipoma associated with hyperthyroidism. 2,10,11 The exact pathogenesis of adrenal myelolipoma is unknown, though it is probably multifactorial, involving gene mutations, growth factors, and hormonal stimulation.…”

Toxicological effects of a herbicide – Pendinmethalin: a case study of Kenana Sugar Industry, White Nile Province, Sudan

“…Therefore, histopathological changes in livers of experimental rats were increased gradual due to increased in serum ALP level for each experimental dose which indicated by column number six in Table 1. Li-Fern and Rajasoorya (1999) stated that elevation in alkaline phosphatase is a medical condition, when the levels of alkaline phosphatase exceed the reference range, this medical condition is clearly observed in dogs that fed 50 mg/kg/day pendimethalin for 2 years, but no medical conditions were observed at dose 12.5 mg/kg/day pendimethalin (Weed Science Society of America, 1994). The medical condition were no observed at dose 40 mg/kg/day pendimethalin mg/kg/day pendimethalin for 90 day feeding study rats (USEPA, 1987).…”