Transient Hyperphosphatasemia Of Infancy Research Articles

Transient hyperphosphatasemia of infancy and early childhood: a less common encounter - a concern for the paediatrician

Transient hyperphosphatasemia (TH) is a benign condition in which serum alkaline phosphatase (ALP) is transiently elevated in the absence of other systemic diseases. It rarely occurs in infants and children under 5 years and is very rarely seen in adults. The differential diagnosis may include bone, intestinal, liver, kidney, intestinal, placental and blood diseases as well as other serious conditions, as well as bone fracture due to accidental or non-accidental injuries. The exclusion of such differential diagnosis before establishing the diagnosis of TH is crucial. We present a case of a nine-month-old girl who was found to have transient hyperphosphatasemia, while she was being investigated for failure to thrive. This case report aims to reinforce that hyperphosphatasemia is a benign phenomenon and diagnostic procedures that are invasive and costly should be avoided.

Normal Bone Turnover in Transient Hyperphosphatasemia

Transient hyperphosphatasemia of infancy and early childhood (THI) is characterized by a temporary isolated elevation of serum alkaline phosphatase activity (ALP), predominantly its bone or liver isoform, in either sick or healthy children under 5 years of age. Return to normal ALP levels usually occurs within four months. Spontaneous rise of ALP might concern the physician, especially when treating seriously ill children. However, THI is considered a benign biochemical disorder with no clinical consequences. Some existing reports support the hypothesis that THI is a result of increased bone turnover. We present evidence of normal bone turnover in two children with THI. In a one-year-old girl and a boy of the same age, high ALP levels (31 and 109 μkat/L, respectively) were accidentally detected. The children had no signs of metabolic bone disease or of liver disease. The high ALP levels returned to normal in two months, thus fulfilling the diagnosis of THI. In both patients, serum parathyroid hormone and bone turnover markers, serum CrossLaps, and serum osteocalcin were neither elevated, nor did these markers follow the ALP dynamics, thus reflecting normal bone turnover in THI. Children with THI should be spared from extensive investigations and unnecessary vitamin D treatment. Conflict of interest:None declared.

Isolated idiopathic transient hyperphosphatasemia in an adult patient after renal transplantation: a case report

Transient hyperphosphatasemia (TH) is characterized by the isolated elevation of serum alkaline phosphatase (ALP) in children. There is no evidence of liver or bone disease and the ALP levels return to normal within 4 months. Few adult cases have been reported. Here, we report the case of TH in a 54-year-old woman, who for 4 years after receiving a renal transplant, was regularly followed up at a renal outpatient clinic. Her underlying disease was chronic glomerulonephritis, for which she was taking immunosuppressive drugs (cyclosporine and mycophenolate mofetil). Routine laboratory analyses revealed that her ALP level had risen to 909 IU/l, which is a seven-fold increase relative to the upper normal limit (35 - 130 IU/l). The levels of intact parathyroid hormone; the tumor markers CEA, α-FP, CA 19-9, and CA 125; and other serum parameters were normal. The patient lacked symptoms, relevant clinical signs, and evidence of acute infection or acute chronic gastrointestinal disease. Lymph node enlargement and malignancy were not detected on a physical examination and ultrasonographic analysis of the abdomen, respectively. A bone scan showed no evidence of bone pathology. ALP isoenzyme analysis by electrophoresis showed patterns similar to those seen in TH of infancy and childhood. The ALP levels of the patient returned spontaneously to 126 IU/l 5 months after diagnosis. While isolated hyperphosphatasemia in renal transplantation patients may be a benign condition, we recommend that such cases be differentially diagnosed from other diseases that can trigger hyperphosphatasemia, including malignancy, infection, bone and liver diseases.

Transient hyperphosphatasemia of infancy and childhood in a boy with idiopathic persistent hyperphosphatasemia

Transient hyperphosphatasemia of infancy and childhood in a boy with idiopathic persistent hyperphosphatasemia

Idiopathic Severe Elevation of Serum Alkaline Phosphatase Following Adult Renal Transplantation: Case Reports

Transient hyperphosphatasemia (TH) in infancy is a benign condition characterized by elevated alkaline phosphatase (ALP) levels severalfold the adult upper limits, occurring mainly in children under 5 years, without evidence of liver or bone disease, and a return to normal ALP levels by 4 months. Herein we have reported 3 cases of TH in adults following renal transplantation. The first case, a 47-year-old woman, blood group AB positive, had hypertensive renal disease. Five months after successful renal transplantation from a deceased donor she had a 50-fold increase in ALP. The second case, a 34-year-old man, blood group A positive, had renal failure due to IgA nephropathy. Nine weeks after a second renal transplant from a deceased donor a 25-fold increase in ALP was noted. The third case, a 45-year-old woman, blood group A positive, experienced renal failure 15 years earlier of unknown etiology. Thirteen years after her second renal transplant a 12-fold increase in ALP was observed during a routine follow-up. In all cases, the isolated ALP serum levels returned to normal limits within 12 weeks. Bone scans and abdominal ultrasounds during these periods were normal with no evidence of bone or liver disease. ALP isoenzyme electrophoresis revealed a pattern characteristic of TH of infancy and childhood. The 3 cases reported highlight the occurrence of benign TH in adults, with renal transplantation. However, liver disease, bone disease, and infection should be excluded first in these susceptible individuals on immunosuppression before establishing the diagnosis of TH.

Transient hyperphosphatasemia after pediatric liver transplantation

Transient hyperphosphatasemia of infancy and early childhood is characterized by transiently increased serum activity of alkaline phosphatase (ALP), predominantly its bone or liver isoform, in children under 5 years of age. There is little information on the rate of transient hyperphosphatasemia in pediatric liver transplant recipients. Patients who underwent liver transplantation at Ege University Organ Transplantation and Research Center, Izmir, Tureky, between January 1998 and January 2005, were included in the study. A total of 70 paediatric liver recipients' medical records were analyzed retrospectively. Transient isolated hyperphosphatasemia was observed in two of 70 patients and the rate of transient hyperphosphatasemia was estimated to be 2.8% in pediatric liver transplant recipient. Diarrheal episode was noted prior to the peak ALP activity in both cases. In one case the causative agent was not found, whereas in the other case Rotavirus was detected in a stool specimen. ALP activity normalized at 4 months and 18 days in the first and second cases, respectively. They continue follow up at the outpatient clinics with stable graft function. It is important to know that very high ALP levels can be seen without underlying significant pathology and the benign nature of the condition to avoid unnecessary investigations.

A case of transient hyperphosphatasemia of infancy and early childhood in an HIV-positive adult possibly related to atazanavir

A case of transient hyperphosphatasemia of infancy and early childhood in an HIV-positive adult possibly related to atazanavir

Benign Transient Hyperphosphatasemia of Infancy and Childhood

Six children, aged 11 to 25 months, were found to have elevated serum alkaline phosphatase (ALP) levels (1,077 to 9,271 U/L) in the absence of disease. Benign transient hyperphosphatasemia (BTH) was diagnosed when the serum ALP levels returned to normal or decreased significantly within 3 months. Several theories have been suggested regarding the pathophysiology of BTH, but the exact cause is still unclear. We report six cases of BTH and review the literature. It is important to recognize this condition and to avoid extensive and unnecessary evaluation.

Transient Hyperphosphatasemia of Infancy and Childhood: Study of 194 Cases

Transient hyperphosphatasemia of infancy and childhood (TH) is a temporary and isolated increase of serum alkaline phosphatase (ALP; EC 3.1.3.1) activity occurring without obvious cause during the first years of life. Despite several reports about this phenomenon, the origin of TH remains obscure. Over a period of 8 years (1992–1999), we detected 194 cases of TH in 106 boys and 88 girls. The hyperphosphatasemia was discovered fortuitously during routine investigations in outpatient and inpatient departments of a children’s hospital with a capacity of 500 beds. A wide variety of clinical disorders was associated with this condition (gastrointestinal diseases, 24%; respiratory infections, 21%; congenital anomalies and …

"Transient hyperphosphatasemia of infancy and childhood" in an adult

"Transient hyperphosphatasemia of infancy and childhood" in an adult

Failure to Thrive in Children With Hyperphosphatasia-Reply

In Reply .—This letter is in response to the letter you received from Dr Goldstein of the Indiana University School of Medicine, Indianapolis. He wrote you regarding my article on Isoenzyme Studies in Transient Hyperphosphatasemia of Infancy. 1 Dr Goldstein's suggestion was that the marked elevation of alkaline phosphatase may be due to bone resorption and/or liver degeneration secondary to acute severe malnutrition. This seems to be a very unlikely explanation in view of the fact that of the children with this syndrome who have had bone x-ray films, no abnormalities have been noted. In addition, vitamin D studies, although not done very frequently, have yielded normal results. Likewise, in those patients who have had extensive studies of the liver, ie, ultrasound, no abnormalities have been noted. It would seem that if the cause for marked elevation of alkaline phosphatase was bone resorption and liver degeneration secondary to malnutrition, more

TRANSIENT HYPERPHOSPHATASEMIA OF INFANCY

To evaluate the clinical characteristics of transient hyper-phosphatasemia of infancy (THI), a syndrome of marked benign transient increase of serum alkaline phosphatase (SAP), we retrospectively studied eight patients with the following: 1) SAP > 3x upper limits of normal, 2) no hepatobiliary, metabolic, neoplastic, or osseous abnormality, 3) SAP level returning to normal without therapy. Mean age was 9.5 months, range 3-14 months; five patients were female. Mean maximum SAP was 2,460 IU/dl, range 1115-7276 IU/dl; mean time for SAP to normalize was 4.6 weeks (range 1.5 - 8 weeks); six patients (63%) had gastrointestinal symptoms (gastroesophageal reflux, food allergy, chronic diarrhea). One patient was < 5th percentile for weight. Serum calcium, phosphorus, transaminases, and bilirubin were normal. Skeletal radiographs and bone scans were normal. We conclude: 1) in infants, extreme elevations of SAP are often benign; 2) a minimal workup should include skeletal radiographs and liver function studies; 3) SAP should be repeated biweekly, and if decreasing extensive studies should not be performed. Because of high incidence of gastrointestinal (GI) symptoms we speculate that THI may be secondary to an acute GI injury with transmucosal passage of liberated intestinal alkaline phosphatase.

Origin of anodally migrating alkaline phosphatase isoenzyme in transient hyperphosphatasemia of infancy.

Journal Article Origin of anodally migrating alkaline phosphatase isoenzyme in transient hyperphosphatasemia of infancy. Get access S B Rosalki, S B Rosalki Search for other works by this author on: Oxford Academic Google Scholar A Y Foo A Y Foo Search for other works by this author on: Oxford Academic Google Scholar Clinical Chemistry, Volume 29, Issue 7, 1 July 1983, Page 1444, https://doi.org/10.1093/clinchem/29.7.1444a Published: 01 July 1983

More on transient hyperphosphatasemia of infancy.

Journal Article More on transient hyperphosphatasemia of infancy. Get access S B Rosalki, S B Rosalki Search for other works by this author on: Oxford Academic Google Scholar A Y Foo A Y Foo Search for other works by this author on: Oxford Academic Google Scholar Clinical Chemistry, Volume 29, Issue 4, 1 April 1983, Page 723, https://doi.org/10.1093/clinchem/29.4.723 Published: 01 April 1983

Transient hyperphosphatasemia of infancy--an insufficiently recognized syndrome.

Spectacular transient increases in serum alkaline phosphatase were observed in five infants in the absence of demonstrable pathology.