Last week we took Nate to his endo for his quarterly appointment. At his new practice they do not do a finger stick HBA1C like they did at his previous practice. They do a full blown blood draw and run 'the works' to make sure everything is on track. Nate has not had his blood drawn since his diagnosis and even at that time we were never given any information on what tests were run or what the results were.
Type 1 diabetics run the risk of several other endocrine issues so I was thrilled to get a full work up and anxious to get the results back. Almost everything looks pretty good. His A1C is down an entire point, no thyroid problems, his cholesterol is good. A few issues --- his triglyceride results are high and his HDL is low which apparently is somewhat normal for T1 children. His alkaline phosphatase results came back extremely high and when I say HIGH --- I'm not even kidding. They should be somewhere between 200 - 400 and his came back at 3,017. What does this mean? I honestly just don't know - I've been on Dr. Google all day and I can't wrap my head around all of the things that it could mean but for now Nate's dr. is running more tests which should give us more answers soon.
And . . . if all of the the test results come back normal then they think he may have a case of Benign Transient Hyperphosphatasemia.
Here is the information that I was sent - It's a lot to digest so please feel free to bypass. :)
Transient hyperphosphatasemia (TH) of infancy and early childhood is characterized by a marked elevation of serum alkaline phosphatase in the absence of detectable liver or bone disease, and a return to normal levels within weeks or months. The condition is thought to be benign; thus, this disorder is also called benign transient hyperphosphatasemia. Recognition of this phenomenon permits avoidance of unnecessary procedures and concerns, provided that underlying liver and bone disease are appropriately excluded.
The clinical presentation and evaluation of an infant or young child with marked elevation of serum alkaline phosphatase will be reviewed here. Evaluation of an older child or adult with elevated alkaline phosphatase, or of any individual with elevations of multiple liver enzymes, is discussed separately. (See "Alkaline phosphatase and other enzymatic measures of cholestasis" and "Approach to the patient with abnormal liver function tests".)
The prevalence of TH is not known. In a series of 260 healthy infants, three (1.5 percent) had unexplained and transient elevations in serum AP, all more than three times the upper limit of normal for the assay . Similar prevalence rates were seen in a separate study in which serum alkaline phosphatase levels >1000 U/L (2.5 times the upper limit of normal) were found in 2.8 percent of healthy children under two years of age. More moderate elevations of alkaline phosphatase, between 400 and 1000 U/L, were found in 5.1 percent of the subjects .
Most children with TH are healthy, although TH has occurred in association with a variety of clinical conditions, including gastroenteritis, respiratory infection, failure to thrive, and asthma. TH has also been reported with viral infections such as respiratory syncytial virus [16-18], enteroviruses , and HIV ; following liver [21,22] or kidney transplant ; and in children receiving chemotherapy for leukemia and lymphoma [11,23]. Some of these apparent disease associations may reflect more frequent laboratory testing to monitor the underlying disease. Indeed, in the largest study that prospectively evaluated a healthy population of infants and toddlers, no association with growth parameters was found . A seasonal distribution of cases has been noted in some series, with more cases identified in late summer and early fall [5,11].
Measurement of alkaline phosphatase isoenzymes by electrophoresis can be helpful if this test is available. The presence of excessive bone and liver fractions supports the diagnosis of TH and argues against primary hepatic or bone disease. (See "Alkaline phosphatase and other enzymatic measures of cholestasis".)
The possibility of rickets should be raised by low serum levels of 25-hydroxyvitamin D with low serum calcium and/or phosphorus, elevated levels of PTH, a history of risk factors for vitamin D deficiency (exclusive breast feeding without vitamin D supplementation), or typical skeletal abnormalities. Any of these findings should prompt further evaluation for rickets, with radiographs of long bones. (See "Overview of rickets in children".)
Bone pain or other bone abnormalities should be evaluated radiographically for evidence of tumor, fracture, or juvenile Paget disease (a rare autosomal recessive disorder of bone turnover associated with bone deformities and susceptibility to fracture). Limb pain also can be caused by a variety of orthopedic, infectious, rheumatic, and neoplastic disorders, as discussed separately. (See "Clinical manifestations and diagnosis of Paget disease of bone" and "Clinical assessment of the child with suspected cancer", section on 'Bone and joint pain' and "Overview of the causes of limp in children".)
- Transient hyperphosphatasemia (TH) of infancy and early childhood is characterized by a marked elevation of serum alkaline phosphatase (AP) in the absence of detectable liver or bone disease. Almost all cases occur in infants and children younger than five years of age. (See 'Clinical presentation' above.)
- In TH, the serum AP is typically elevated four to five times the upper limit of the pediatric reference range, and gradually returns to normal within two to three months. (See 'Clinical presentation' above.)
- Serum AP activities are higher in children than in adults because of physiological osteoblastic activity. The upper limit of the pediatric reference range is up to three times higher than in adults, peaking in late infancy and again during puberty (graph 1). (See 'Normal ranges for serum AP' above.)
- TH is characterized by elevations in both bone and liver alkaline phosphatase isoenzymes. The pathogenesis has not been fully established, but is thought to include reduced clearance of AP due to increased sialic acid content, perhaps caused by or compounded by a transient surge in alkaline phosphatase production. (See 'Pathogenesis' above.)
- The evaluation should include a history and physical examination to assess for evidence of primary liver or bone disease. Laboratory testing should include measurement of serum aspartate aminotransferase, alanine aminotransferase, bilirubin, calcium, phosphorus, 25-hydroxyvitamin D, parathyroid hormone, blood urea nitrogen, and creatinine. In addition, measurement of either gamma-glutamyl transpeptidase (GGT) or 5'-nucleotidase helps to exclude liver disease. (See 'Evaluation and management' above.)
- The possibility of rickets should be raised by low serum levels of 25-hydroxyvitamin D, calcium or phosphorus, elevated serum parathyroid hormone, a history of risk factors for vitamin D deficiency such as exclusive breast feeding without vitamin D supplementation, or typical skeletal abnormalities. Any of these findings should prompt further evaluation, including radiographs of long bones. (See 'Laboratory testing' above and "Overview of rickets in children".)
- Even if rickets is excluded, all children should be evaluated to ensure adequate intake of vitamin D and supplemented with at least 400 IU daily if needed. Steps should also be taken to ensure adequate intake of calcium. (See 'Monitoring' above.)
- If there is no evidence of liver or bone disease in an infant or young child, then the provisional diagnosis of TH can be made. Repeat measurement of serum AP should be performed at intervals until normal values are attained. (See 'Monitoring' above.)
That's a lot of info to digest. Does your brain hurt yet? Good luck with the diagnosis. I assume you have to wait a couple months to see if the numbers go down on their own. If that's the case I'm sending you all the patience I can spare. I wish you and Nate well.
Hi my 19 month old has had a rash that my MD believes to be GCS, Gianotti Crosti Syndrome from an unknown cause and while having bloodwork done last week to check her lab values and platelet count bc of suspected petechiae, her ALP came back 4799, we went to MD today and had it rechecked to make sure not lab error and it was 4024. So the MD is consulting some other physicians to see what to do next. I think this may be it. All her other lab work is normal, nothing pointing to bone or liver disorders, bilirubin ast and alt are normal and calcium is normal and she gets plenty of vit d so no rickets. Other than the recent viral infection she has had no other complaints. hopefully this is all it is. Thank you so much for sharing this educated and wel documented information.
My daughter is 12 months and I was doing research on elevations of alkaline phosphatase because she recently had a blood test and her alkaline phosphatase level was actually over 7,000! Needless to say, her pediatrician was pretty shocked and suggested that we run additional bloodwork. I was wondering how you made out with this and whether your son was diagnosed w/ TH. We are still ruling out other issues. She had more blood drawn today (4 vials) and they are going to isolate the alkaline phosphatase to determine if it is due to bone or liver issues, rule out vitamin D deficiency and check her other vitamin levels in her body. Keeping my fingers crossed that it is either TH or some other seemingly innocuous thing.
Marguerite, It was TH and we just had him retested last week and AP is back in range for a growing boy.
We did do another blood draw and everything else was completely normal so no further testing was done at that time. We knew we would re-check him in 3-months and go from there.
I actually just posted his results today.
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