Related Experiment Videos
Transient hyperphosphatasaemia: an important condition to recognize
1Department of Paediatrics and Child Health, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia.
Insights
Transient hyperphosphatasaemia (TH) is a common, benign condition in infants and children, often presenting with gastroenteritis during winter months. Early identification prevents misdiagnosis and unnecessary investigations.
Area of Science:
- Pediatric Endocrinology
- Biochemistry
- Clinical Diagnostics
Background:
- Transient hyperphosphatasaemia (TH) is a condition characterized by elevated alkaline phosphatase (ALP) levels in infants and children.
- Distinguishing TH from other causes of high ALP, such as liver or bone disease, is crucial for appropriate patient management.
Purpose of the Study:
- To determine the prevalence and causes of transient hyperphosphatasaemia (TH) in a pediatric hospital.
- To establish diagnostic criteria for TH in children.
Main Methods:
- Retrospective analysis of medical records for children with plasma alkaline phosphatase (ALP) activity exceeding 1000 U/L.
- Exclusion of liver and bone disease as primary causes of elevated ALP.
Main Results:
- 68 children had ALP > 1000 U/L; TH accounted for 21 cases.
- TH predominantly affected young males (mean age 1y 5m) and showed a winter seasonal peak, often following gastroenteritis.
- Mean ALP in TH cases was 3395 U/L, normalizing within ~70 days.
Conclusions:
- Transient hyperphosphatasaemia (TH) can be identified by age and exclusion of liver/bone disease, revealing a high prevalence.
- Recognizing TH as a benign condition avoids misdiagnosis and unnecessary medical interventions.
Objective:
To investigate the prevalence and aetiology of transient hyperphosphatasaemia (TH) of infancy and childhood in a tertiary referral paediatric hospital.
Methodology:
Retrospective review of the medical records of patients with measured plasma alkaline phosphatase (ALP) activity of over 1000 U/L.
Results:
Over a period of 1 year, 68 children with plasma ALP activity of over 1000 U/L were identified. The main aetiologies were liver disease (34 cases), TH (21 cases) and bone disease (11 cases). The mean age of children with TH was 1 year and 5 months and there was a male predominance (3:1). The children with liver and bone disease were older (mean ages of 6 years, 6 months and 5 years, 1 month, respectively) and there was no gender difference. The mean plasma ALP activity for the children with TH was 3395 U/L, and in those patients in whom ALP activity was measured sequentially, mean ALP returned to within normal limits after an average of 70 days. There was a seasonal predominance of TH cases, with a significant number presenting during the winter, suggesting a viral aetiology. The most common clinical presentation of children with TH was gastroenteritis (8/21).
Conclusion:
Cases of TH can be clearly identified by considering the age of the patient and by excluding other known causes of markedly elevated ALP, in particular liver or bone disease. Using these exclusion criteria, the prevalence of TH was found to be high. Early recognition of this benign condition may prevent misdiagnosis and further unnecessary investigations.