Transient Hyperphosphatasemia Research Articles

Benign transient hyperphosphatasemia in the pediatric population: a single center cohort study.

Alkaline phosphatase (ALP) can be increased in a benign condition known as benign-transient hyperphosphatasemia (BTH). We aimed to evaluate the demographic, and clinical characteristics of infants and children with BTH. In our retrospective study, infants and children diagnosed with BTH between September 2019 and September 2023 were included. Of 249 children with elevated ALP levels, 95 (38.1 %) had BTH. The mean age at diagnosis of children with BTH was 2.4±1.3 years (min 0.6- max 6.2 years). ALP mean value was 2,587±1252 U/L (min 972- max 5757 U/L). ALP value was an average 7.4±3.6 times higher than the corresponding upper limit of normal. The second measurement was made after an average of 13.2±6days, and a statistically significant difference was detected compared to the first value, with a decrease of 61±23 % in the ALP value (p<0.001). ALP value returned to normal in an average of 44±29.2days. Elevated ALP was detected during infection in 49 (51.6 %) children. When the sample was divided into those under 2 years of age and aged 2 and over, no statistical difference was observed in ALP levels in the time it took for ALP levels to return to the normal range (p=0.480). BTH should be kept in mind if high serum ALP is detected in children without clinical or laboratory suspicion of bone or liver disease. In the follow up detecting a significant decrease trend compared to the first value may be guiding for BTH.

Retrospective evaluation of cases of benign transient hyperphosphatasemia

This study aimed to evaluate the demographic, clinical, and laboratory characteristics of children with benign transient hyperphosphatasemia (BTH) and to increase awareness of BTH. Children with BTH followed up in a tertiary pediatric endocrinology outpatient clinic were included in this retrospective study. Children who were aged under 5 years, who had no evidence of liver, kidney, or bone disease, who had serum total alkaline phosphatase (ALP) levels above 1000 IU/L, and whose ALP values resolved within 4 months, were included in the study. The study included 10 infants and children (4 females) with BTH who were referred to our clinic during 1 year for high ALP levels. The mean age was 2.4±0.5 years. The mean weight SDS was -0.24±1.27 and the mean height SDS was -0.51±0.67. The mean ALP level was 2.395±934 IU/L. The mean normalization time for serum ALP was 2.4±1.1 months. Benign transient hyperphosphatasemia is an entity that occurs in healthy infants and children without evidence of liver or bone disease and resolves without intervention.

Una fosfatasi alcalina non fa rachitismo

The case of an 18-month-old asymptomatic girl with isolated high alkaline phosphatase blood levels is described. The diagnosis of benign, transient hyperphosphatasemia was finally made.

Benign transient hyperphosphatasemia in infants and children: a retrospective database study.

Benign transient hyperphosphatasemia seems to be a disorder described among otherwise healthy infants and children, which resolves spontaneously. Other known causes of markedly elevated serum ALP should be excluded, especially bone and liver disease. Higher awareness and recognition of this benign condition are important in order to avoid unnecessary tests and parental anxiety. • Benign transient hyperphosphatasemia is a benign condition characterized by greatly increased serum alkaline phosphatase without laboratory or clinical evidence of underlying bone or liver disease, which usually resolves spontaneously, with no intervention. • In the case of an incidental finding of high serum alkaline phosphatase in an otherwise healthy infant or child with no other clinical or laboratory suspicion of bone or liver disease, we recommend repeating the alkaline phosphatase level within a few months in order to confirm the resolution of this condition. • When benign transient hyperphosphatasemia is suspected, a "wait and see" approach is optimal in order to avoid unnecessary investigations and parental anxiety.

ДОБРОКАЧЕСТВЕННАЯ ТРАНЗИТОРНАЯ ГИПЕРФОСФАТАЗЕМИЯ У ДЕТЕЙ: 12 НОВЫХ СЛУЧАЕВ И ОБЗОР ЛИТЕРАТУРЫ

Benign transient hyperphosphatasemia of childhood (TH, BTH, BTHC) is a condition characterized by a temporary significant increase in the level of alkaline phosphatase in healthy people. This condition is transient and it does resolve without treatment within 2 to 4 months, does not have any long-term consequences (according to the analysis of the bibliographical sources and the Authors’ own observations). BTH is most often detected in children under the age of 5 y/o with the peak under 2 years, however there are sporadic cases in adults observed. In addition, there are descriptions of familial cases of TH that are clinically identical to the sporadic ones. Authors present twelve own observations of BTH cases and the bibliographical review on the topic. The criteria for BTH diagnosing are formed and a benign course of this condition had been confirmed.

Transient Hyperphosphatasemia Associated with Human Bocavirus Infection

Transient Hyperphosphatasemia Associated with Human Bocavirus Infection

M277 Transient hyperphosphatasemia of infancy: A case report and implementation of a decision algorithm

M277 Transient hyperphosphatasemia of infancy: A case report and implementation of a decision algorithm

Transient Hyperphosphatasemia in an Adolescent and an Adult Renal Transplant Patient

In renal transplant patients receiving immunosuppression, a significant increase in alkaline phosphatase (ALP) might be indicative of liver or bone diseases caused by many factors. In infancy and early childhood, a transient and therefore benign increase in ALP often has been described, usually during a course of infectious disease. Rarely, transient hyperphosphatasemia occurs in adults. We herein present 2 cases of transient hyperphosphatasemia in an adolescent and an adult renal transplant recipient, respectively. In the first case, a 17-year-old adolescent presented with an ALP value up to 2451 U/L, reporting no symptoms. In the second case, a 56-year-old woman with a second well-functioning kidney transplant presented with an ALP value up to 1532 U/L, without symptoms. In both cases, the biochemical profile and ultrasound study were negative for liver disease while no viral or other type of infection was detected. Bone scanning was within normal range and parathyroid hormone was also normal. However, bone ALP was measured at 8.9 and 11.9 times, respectively, above reference values. ALP electrophoresis had a characteristic pattern with involvement of both liver and bone-specific isoforms. About 6 weeks after their peak, ALP values gradually returned to normal range. Benign transient hyperphosphatasemia, although rare, should be considered in the differential diagnosis of isolated ALP increase, even in adult patients with kidney transplant. Electrophoresis of ALP could narrow the diagnostic procedure in cases when neither liver nor bone disease is clinically apparent.

Transient Hyperphosphatasemia Following Pediatric Kidney Transplant.

IntroductionTransient hyperphosphatasemia (TH) is a rare benign condition of elevated serum alkaline phosphatase (AP) levels seen in healthy children. TH has been reported to occur in pediatric solid organ transplants, including kidney transplant patients. Little is known about TH in pediatric kidney transplant patients.ObjectiveTo evaluate the incidence and natural history of TH in pediatric kidney transplant patients.MethodsA retrospective chart review of patients < 18 years of age who underwent kidney transplantation at the University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh between 2008 and 2019 was performed to identify patients with TH, defined as an AP level greater than 1,000 IU/L. Exclusion criteria included repeat kidney transplants or kidney transplant as part of a multiorgan transplant.ResultsOne hundred seventy-six patients underwent a solitary kidney transplant, of which 87 were less than 12 years of age. Eleven patients (6.5%) were found to have TH, all of whom were < 12 years of age (12.8%) (median age: 5 years; range: 1 - 11 years). The median AP level prior to transplant was 183 IU/L (range: 104 - 309 IU/L) and the median peak AP was > 2,300 IU/L (range: 1,227 - 4,912 IU/L). The median time from a kidney transplant to the diagnosis of TH was 0.6 years (range: 0.3 to 7.7 years). The median length of time that TH persisted was 0.5 years (range: 0.2 to 0.9 years). The median estimated glomerular filtration rate (GFR) at the time of diagnosis of TH was 84 mL/min/1.73m2 per the bedside Schwartz equation (range: 45 to 152 mL/min/1.73m2). One patient had variable AP levels over nine months prior to resolution; the other 10 patients had a solitary peak of AP prior to resolution. No patient required treatment of elevated AP levels and the TH resolved spontaneously without intervention. No patients had significant abnormalities of markers of metabolic bone disease or were on active vitamin D, calcium, or phosphorus supplements. Two patients reported bone pain, and one patient was found to have avascular necrosis of the hip.ConclusionsTH is a relatively common finding following a pediatric kidney transplant in pre-pubertal children less than 12 years of age. It primarily occurs in the first year following a kidney transplant and usually resolves without recurrence within one year of onset.

Transient hyperphosphatasemia: Possible association with pediatric acute respiratory infection.

ABSTRACTImportanceAcute respiratory infections are quite prevalent in children. Transient hyperphosphatasemia (TH) is defined as the transient elevation of serum alkaline phosphatase (ALP) level, which occurs mainly in infants and children without liver or bone disorders. Although no apparent cause has been identified, a possible association of respiratory infections with TH has been reported in the literature.ObjectiveIn this study, we aimed to investigate the association between TH and respiratory infectious diseases.MethodsWe collected the results of biochemical investigations, including ALP level, for a period of 5 years in our hospital. We then examined the patients with transiently elevated ALP levels of > 2000 U/L.ResultsDuring the observation period, 1501 blood samples were collected from 1097 patients. Marked elevation of serum ALP level was observed in 12 patients. All patients with hyperphosphatasemia, except for one with Fanconi syndrome attributable to the underlying Wilson’s disease, were aged < 5 years and were diagnosed with TH. Ten of these 11 patients with TH had acute respiratory infections. Marked ALP elevation was not found in any patients with non‐inflammatory diseases. ALP isoenzyme profiles showed a characteristic pattern in all six patients in whom the ALP isoenzyme test was conducted.InterpretationOur results suggest an association between respiratory infections and TH. The consideration of TH in patients with acute respiratory infections may lead to earlier and accurate diagnosis of this condition, thereby avoiding unnecessary medical interventions.

A case of transient hyperphosphatasemia presenting with mild degree of bow legs

Introduction: Transient Hyperphosphatasia (TH) is a benign condition in which serum Alkaline Phosphatase is elevated without any underlying pathology. This is mainly seen in children compared to adults and it is usually an incidental finding. The hallmark of the condition is that normalization of ALP level will with time. However, not knowing the entity would lead to unnecessary investigations and referrals. Here we report a child with TH who presents with a mild degree of bow legs. Case report: A 1year and 8 months old boy was brought by his mother with a concern of bow legs. He was the first child born to non-consanguineous healthy parents following normal antenatal and perinatal periods. His birth weight was 3.5kg and he was growing in his birth centile. He had age-appropriate development and parents had been having a concern about bow legs after he started walking. He is getting an average Sri Lankan diet with animal food and he gets adequate sun exposure as well. There was no history to suggest the liver of renal diseases. On examination, he had a mild degree of bow legs without any features to suggest rickets. His cardiovascular, respiratory, abdominal, and neurology exams were normal. His bone profile showed a high value of ALP (3782 U/L) with normal calcium, phosphate, and vitamin D levels. Due to high ALP levels, he underwent liver and renal functions and that was within the normal range. The diagnosis was made as TH and he was followed up monthly with ALP values. He had a downward trend of ALP levels and in 3 months the ALP value dropped to (580 U/L). Parents were reassured about the condition and the diagnosis was confirmed as TH. Conclusion: It is important to rule out, bone, kidney, or a liver pathology if a child has markedly elevated ALP levels. However, it is important to recognize this entity to avoid unnecessary procedures and concerns.

Benign transient hyperphosphatasemia - a cause for alarm or a benign condition

Benign transient hyperphosphatasemia (BTH) is a condition which occurs in children younger than five years, characterized by a complete absence of specific clinical and laboratory findings of bone or liver diseases and a five or even 20–70-fold increase in serum of alkaline phosphatase levels(ALP). The aim of this case report was to point out that elevated levels of ALP are not always related to serious bone and liver diseases. We described three healthy patients, which were referred to our out-patient clinic by their primary care physicians because of markedly elevated levels of ALP. The diagnosis of BTH was based on a thorough physical exam, a wide range of laboratory and imaging tests, which excluded liver or bone disease as a cause for elevated ALP. BTH is not very well-known and managed in daily clinical practice. Primary care physicians should consider this diagnosis in cases with elevated ALP in otherwise healthy infants and toddlers, refrain from unnecessary tests, prescribing higher doses of vitamin D3 or referral to tertiary level pediatric institutions.

An Explosive Workup for Diarrhea: The Cascade Effect From an Incidental Finding on a Laboratory Panel.

A 19-month-old boy with a medical history of 1 febrile seizure presented to the emergency department (ED) with 2 days of vomiting and 1 day of diarrhea. He was accompanied by his non–English-speaking mother, who reported several episodes of nonbloody, nonbilious emesis and dark brown, watery stools. The patient had decreased intake of solid foods, but he had been breastfeeding well. Because of his diarrhea, the patient’s mother was unsure how many voids he had had in the past day. He had not had fevers. The family history was significant for the patient’s father recently being diagnosed with hepatitis C. The patient’s mother brought him into the ED because of his symptoms and concern that he looked “yellow.” In the ED, the patient was afebrile with normal vital signs for his age (including heart rate of 146 beats per minute), and he was “well appearing and active” with moist mucous membranes and a capillary refill of <2 seconds. However, the ED provider additionally documented that the patient appeared “moderately dehydrated [and] slightly jaundiced,” and he ordered a comprehensive metabolic panel (CMP). All values were within normal limits, including total bilirubin, except for a low bicarbonate of 16 mmol/L (normal 21–30 mmol/L) and an elevated alkaline phosphatase (ALP) of 926 U/L (normal 129–291 U/L). The provider consulted endocrinology for the elevated ALP, who noted a broad differential for elevated ALP and that transient hyperphosphatasemia is a diagnosis of exclusion. They recommended checking 25-hydroxyvitamin D, phosphate, and parathyroid hormone to evaluate for underlying parathyroid, vitamin D, and bone disease. They also wrote that the team could check total and isoenzymes of ALP “if desiring further testing to help confirm [the] diagnosis of transient hyperphosphatasemia.” The ED provider obtained these recommended laboratories, including the ALP laboratories, as well as a gamma-glutamyl transferase, acute …

Transient Hyperphosphatasemia in an Adult Identified by a One-day Health Check-up

Transient Hyperphosphatasemia in an Adult Identified by a One-day Health Check-up

Benign transient hyperphosphatasemia in children

Introduction/Objective. Benign transient hyperphosphatasemia (BTH) is a pathogenetic insufficiently clear clinical entity that is mostly seen in infants and young children. The objective of this paper is to present our experience regarding the age of occurrence, the conditions of the discovery, and the length of duration of BTH in children. Methods. The study was realized on a sample of 18 children, nine boys and nine girls, aged 10?42 (21.06 ? 9.35) months with BTH. The diagnosis of BTH is based on the absence of bone and hepatobiliary diseases, and its spontaneous disappearance over the course of several months. Results. One patient was in the first year, 13 in the second, three in the third, and one in the fourth. Isolated high activity of serum alkaline phosphatase, which was 2.04?21.9 (8.05 ? 5.31) times above the upper reference value for the corresponding age, in 14 cases it was found during the acute diarrhea, and in four with acute rhinopharyngitis, of which in two complicated with otitis media. The cause of diarrhea in six cases was rotavirus, in two Campylobacter, and in one adenovirus, and otitis media in one case was caused by Streptococcus pneumoniae, while in others, etiologic factors of infection were not identified. Spontaneous normalization of serum alkaline phosphatase activity was recorded between one and three months after the onset. Conclusion. BTH is a harmless biochemical disorder that spontaneously subsides within three months after initial observation. It is found randomly as a routine laboratory finding most often within the treatment of acute gastrointestinal and respiratory infections.

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.

Transient hyperphosphatasemia in an adult patient under treatment for Behçet’s disease

Transient hyperphosphatasemia in an adult patient under treatment for Behçet’s disease

A case series of benign transient hyperphosphatasemia from a pediatric endocrinology reference health facility in Turkey.

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.

Transient hyperphosphatasemia in a child with nephrolithiasis And history of severe prematurity

Transient hyperphosphatasemia in a child with nephrolithiasis And history of severe prematurity

A harmless clinical condition presenting with dramatic elevation of alkaline phosphatase: bening transient hyperphosphatasemia of childhood

A harmless clinical condition presenting with dramatic elevation of alkaline phosphatase: bening transient hyperphosphatasemia of childhood