Transient hyperphosphatasemia in children revisited

Dori, Neta; Levi, Lily; Stam, Tamar; Sukhotnik, Igor; Shaoul, Ron

doi:10.1111/j.1442-200x.2010.03265.x

Cited by 24 publications

(26 citation statements)

References 29 publications

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“…Four of the 5 patients were female, all younger than 5 years, coincident with what is reported 5,7 , as this condition has been described in children older than this age and/ or in adults 8 , with a similar incidence in both genders 9 . The etiology of BTH is still unknown, but the finding of respiratory and gastrointestinal viral infections, and the temporal coincidence with antibodies against different enteroviruses, leads to a probable infectious etiology 10 ; seasonality, another cause that would support this hypothesis, has not been consistent in all case reports, and it was not found in our series either 9,11 . Other authors associate the transient ALP increase to an abnormal growth and development, which has not been demonstrated yet 5 .…”

Section: Discussioncontrasting

confidence: 52%

Hiperfosfatasemia transitoria benigna de la infancia, Serie Clinica

Rocha

2016

Revista Chilena de Pediatría

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Introduction: Alkaline Phosphatase (ALP) is a group of 4 isoenzymes produced in different tissues. Elevated levels of ALP can be developed under physiological conditions, and can indicate the presence of bone or hepatobiliary diseases. In children, one of its most common harmless causes is benign transient hyperphosphatasemia (BTH), a little known condition. The objective is to report BTH cases and propose a monitoring plan. Case reports: The cases of 5 children aged between 11 and 50 months are presented, 4 of them female, with the incidental finding of a sudden and severe ALP elevation (> 1,000 U/l), in tests ordered due to either abnormal growth and development, or intercurrent infections. Bone and liver disease were ruled out using the patient history, physical examination and basic laboratory results. Isoenzymes levels were determined in 2 patients. A return to normal ALP levels was observed over a period of 1-6 months, with no evidence of further complications. Conclusion: BTH is a benign self-limiting biochemical disorder, which should be considered in children under 5 years old with severe ALP elevation in the absence of clinical or laboratory abnormalities suggestive of bone or liver disease.

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Section: Discussioncontrasting

confidence: 52%

Hiperfosfatasemia transitoria benigna de la infancia, Serie Clinica

Rocha

2016

Revista Chilena de Pediatría

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“…Despite numerous reports on this condition, the underlying cause of TH remains obscure. Suggestions for mechanisms have involved triggering by infections, failure to thrive, alterations in vitamin D or drugs [2,5,6,11,15,16,17]. Such events may be followed by increased synthesis or decreased clearance, e.g.…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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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“…Another increase of serum ALP (2-to 3-fold higher than in adult levels) occurs at puberty, and it can remain at this elevated level for 1 or 2 years. 3,4 BTH of infancy and early childhood is a situation of transient and marked elevation of serum ALP in infants and toddlers of both sexes without any evidence of bone or liver disease. BTH is not sufficiently recognized or even suspected by most primary care pediatricians because textbooks either do not mention it or discuss it only briefly.…”

Section: Epidemiologic and Clinical Datamentioning

confidence: 99%

An 18-Month-Old Boy with Diarrhea and an Elevated Biochemical Parameter

Shapira¹,

Shaoul²

2015

Pediatr Ann

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A n 18-month-old boy presented to his primary care pediatrician with a complaint of diarrhea for the past 5 days. The diarrhea was frequent, watery, but without mucus or blood. The diarrhea was not associated with vomiting, fever, cough, or skin rash. His past medical history is significant only for mild asthma, and his immunizations are up-to-date.The physical examination revealed an alert, well-developed boy with a weight of 11.9 kg (54th percentile), height of 84.5 cm (77th percentile), and normal vital signs. His abdomen was soft, nontender, and without hepatosplenomegaly or signs of dehydration. The rest of the physical examination was normal.A clinical diagnosis of viral gastroenteritis was made and oral rehydration therapy and dietary modifications were recommended. After 3 days he returned to the clinic because of the persistence of the diarrhea, and there were still no other symptoms. Once again, the results of his physical examination were normal. Because of the continuation of the diarrhea, laboratory tests (blood, urine, and stool) were performed, and the results were as follows: hemoglobin, 11.5 g/dL; white blood cells, 9.2 10 3 /mcL; platelets, 367 10 3 /mcL (with a normal differential count); C-reactive protein, <0.5 mg/dL; glucose, 75 mg/dL; urea, 25 mg/dL; creatinine, 0.20 mg/dL; potassium, 4.3 nmol/L; sodium, 138 nmol/L; protein, 6.2 g/dL; albumin, 4.1 g/dL; bilirubin, 0.20 mg/dL; ferritin, 20 ng/mL; asparate aminotransferase, 37 U/L; alanine aminotransferase, 26 U/L; gamma-glutamyl transpeptidase, 5 U/L; calcium, 9.3 mg/dL; and phosphorus, 4.9 mg/dL. Urinalysis was normal, and stool for culture, ova, parasites, Giardia lamblia antigen, rotavirus, and adenovirus was negative. Blood serology was negative for Epstein-Barr virus (EBV), hepatitis C, and for immunoglobulin M cytomegalovirus (CMV) antibodies, and positive for immunoglobulin G CMV antibodies, indicating a past infection with CMV.An elevated biochemical parameter in the blood revealed a condition that may be associated with the clinical presentation (gastroenteritis) described, appearing mainly in infancy and early childhood.

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Transient hyperphosphatasemia in children revisited

Abstract: We could not establish an etiological explanation for TH. We presume that it is a complex mechanism in which different stimuli led to upregulation of the enzyme.

Cited by 24 publications

References 29 publications

Hiperfosfatasemia transitoria benigna de la infancia, Serie Clinica

Hiperfosfatasemia transitoria benigna de la infancia, Serie Clinica

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

An 18-Month-Old Boy with Diarrhea and an Elevated Biochemical Parameter

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