Abstract

Transient Hyperphosphatasemia (TH) is a benign condition in which serum alkaline phosphatase (ALP) is transiently elevated in the absence of other systemic diseases. It mainly occurs in infants and children and infrequently happened in adults. The differential diagnosis may include liver, bone, kidney, intestinal, placental and blood diseases as well as accidental or non-accidental bone fracture.

Case presentation: In this report, we present a 3-year-old boy with TH and compare their clinical course with the natural history of TH mentioned in literature. The 3-year-old male child was visiting in our paediatric clinic of Taleghani Hospital, Gorgan, Iran as routine height and weight follow-up. He was healthy with normal development. She fed on breastfeeding, regular diet and he was on no treatment. On examination, her anthropometric indices and growth were relevant to his age and thus normal with unremarkable systemic examination suggesting organic disease or child abuse. His initial screening blood tests at first year of age, out of the blue, he was found to have an elevated serum alkaline phosphates (ALP) level of 7298U/L, which had decreased to 2580/L a week after (child normal lab value 180-1200U/L). All her other investigation was detected normal (Table 1). When followed in clinic, the ALP level started to drop dramatically from 2580U/L to 636,354 U/L within a month. It remained within normal range while his twice a year visits until now (3 year-old); the patient’s family looked healthy and reported no systemic complaint

Table 1: Assessment of our case at presentation and during follow-up

Investigations	At presentation	After 1 month	After 3 months	After 2 years
ALP (N=175-1200 u/l)	7298	2580	636	271
25(OH) VIT D (optimal=30-50 ng/ml)	-	37	-	-
PTH intact (N=14.5-87.1 pg/ml)	2.69	24.7	-	-
Ca (N=8.8-10.8 mg/dl)	-	10.8	10.7	10.7
Phosphorus (N=4-7 mg/dl)	-	6.55	6	6.1
AST (N=10-31)	32	10
ALT (N=15-41 u/l)	37	13	-	-
WBC (N=8000-1200 )	9200	9000	-	8500
Urea (N=1.8-6.4 mmol/l)	4.2	-	4.5	4
Serum creatinine (N=27-62 umol/l)	26	-	40	38
Gamma-glutamyl transferase (GGT)	10	-	-	11
ESR 1hr (mm)	10	-	-	9
Radiology: Wrist X-ray, Growth plate	-	Normal	-	Normal
Ultrasonography: Abdomen and pelvic	-	Normal	-	-

Conclusion: Though no accurate estimation of its prevalence worldwide, transient Hyperphosphatasemia (TH) seems to be rarely encountered in our community, as elsewhere in the world. Our report, which was the first case of Iranian TH, showed a classic natural history of the disease with emphasis on awareness to such condition in practice

Keywords

Alkaline phosphatase, Hyperphosphatasemia, Transient, idiopathic, Iran