Abstract
IntroductionBenign transient hyperphosphatasemia (BTH), even a known condition, is not very well managed by primary care physicians. The diagnostic criteria for BTH were alkaline phosphatase (ALP) levels above 3-5 times greater than the age adjusted upper limit of normal among children under 5 years with no evidence of liver or bone disease whose ALP values resolved within 4 months.MethodsThis study involved 15 patients aged 0-5 years, who were referred to the pediatric endocrinology clinic for elevated ALP levels. They were diagnosed with BTH. We examined demographic and biochemical parameters including ALP and ALP isoenzymes, liver enzymes, calcium, phosphate, and parathormone (PTH) levels to rule out liver or bone disease as a cause for hyperphosphatasaemia.ResultsOf 15 patients 7 were male and 8 were female. Mean age was 2.45 ± 1.09 (range 1.2-4.6) years. Mean serum ALP level was 2315 ± 1028 IU/L (1102-4662), while liver enzymes, calcium, phosphate, PTH and vitamin D3 levels were in normal ranges. The mean normalization period of ALP was 2.4 ± 1.1 (0.5-4) months, and all were normal at the end of 4 months without any treatment.ConclusionThis study and literature knowledge related to BTH has shown that being aware of BTH is very important for a primary care physician. Paediatricians can conveniently manage the differential diagnosis and follow up this period of elevated ALP.
Highlights
Benign transient hyperphosphatasemia (BTH), even a known condition, is not very well managed by primary care physicians
The benign elevation of alkaline phosphatase (ALP) is referred to as benign transient hyperphosphatasaemia (BTH), a condition most commonly observed in infants and children younger than 5 years of age [3]
Incorporating Kraut's original diagnostic criteria, updated with more recent relevant literature, a presumptive diagnosis of BTH was made by Chu [5] et al with the following: significantly elevated ALP level; age < 5 years; history and physical examination not suggestive of bone or liver disease; normal liver tests; normal electrolytes, calcium, blood urea nitrogen and creatinine; ALP isoenzymes show an absolute elevation of both bone and liver fractions, but the relative predominance may be of bone, liver, or mixed origin; normal PTH and 25-hydroxy vitamin D levels; confirm BTH with a normalizing ALP level within 3 to 4 months
Summary
Benign transient hyperphosphatasemia (BTH), even a known condition, is not very well managed by primary care physicians. The diagnostic criteria for BTH were alkaline phosphatase (ALP) levels above 3-5 times greater than the age adjusted upper limit of normal among children under 5 years with no evidence of liver or bone disease whose ALP values resolved within 4 months. Characteristic features of BTH defined by Kraut [4] et al including; age of presentation less than five years; no other evidence for bone or liver disease on physical examination or laboratory findings; elevation in both bone and liver ALP isoenzymes; and a return to normal serum ALP values within four months. The aim was to give information about the relationship between clinical features and recovery time
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