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Elevated serum alkaline phosphatase · generalized pruritus · Dx?
Alexander M Sy1,2, Nora V Bergasa1,2
1Department of Medicine, Metropolitan Hospital Center, New York, NY, USA.
The Journal of Family Practice
|February 6, 2018
Summary
This case study highlights a pregnant woman with elevated alkaline phosphatase (ALP) and pruritus. Further investigation is crucial for diagnosing and managing liver conditions during pregnancy.
Area of Science:
- Hepatology
- Obstetrics
- Internal Medicine
Background:
- A 34-year-old pregnant woman presented with generalized pruritus and elevated serum alkaline phosphatase (ALP).
- Her obstetric history included two live births and two spontaneous abortions.
- She had no significant past medical history or family history of liver disease.
Observation:
- Physical examination revealed acanthosis nigricans and scattered excoriations.
- Serum ALP levels were significantly elevated (1093 U/L, normal: 50-136 U/L), peaking at 1134 U/L by 37 weeks' gestation.
- Liver function tests, including transaminases, albumin, bilirubin, and prothrombin time, were within normal limits.
Findings:
- Fasting serum bile acid concentration was normal (9 mcmol/L, normal: 4.5-19.2 mcmol/L).
- The patient's ALP levels were normal prior to pregnancy.
- The elevated ALP and pruritus in the third trimester of pregnancy suggest a potential pregnancy-related liver condition.
Implications:
- This case underscores the importance of monitoring liver function during pregnancy, especially in the presence of symptoms like pruritus.
- Further diagnostic workup is necessary to determine the etiology of the elevated ALP and pruritus.
- Timely diagnosis and management are essential for maternal and fetal well-being.
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