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

Introduction: Benign 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. Methods: This 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. Results: Of 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. Conclusion: This 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.