Medical History
Premature loss of baby teeth with root intact, 2 nontraumatic fractures in his teenage years, kidney stone 2 years ago, ALP value reported as 30 U/L* on lab results 2 years ago.
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Case Study:
Identifying and Diagnosing HPP.
Case Study: Identifying and Diagnosing HPP.
A 52-year-old man referred to an endocrinologist for fatigue and pain.
Hypothetical patient case.
Premature loss of baby teeth with root intact, 2 nontraumatic fractures in his teenage years, kidney stone 2 years ago, ALP value reported as 30 U/L* on lab results 2 years ago.
High school teacher for the past 25 years, denies tobacco or alcohol use.
Osteoporosis (mother); hypertension (father, myocardial infarction at 67).
Over-the-counter medication twice daily for pain, calcium and vitamin D supplement once daily.
(H) = high, (L) = low.
*Age- and sex-adjusted normal range for adults, >20 years and older, 40-120 U/L.1-5
Check with your lab for their appropriate age and sex-adjusted reference range.
References: 1. Adeli K, et al. Clin Chem. 2015;61(8):1049-1062. doi: 10.1373/clinchem.2015.240515 2. Schumann G, et al. Clin Chem Lab Med. 2011;49(9):1439-1446. doi: 10.1515/CCLM.2011.621 3. Quest Diagnostics. Alkaline phosphatase. Accessed July 28, 2021. https://testdirectory.questdiagnostics.com/test/test-detail/234/alkaline-phosphatase? cc=MASTER 4. Labcorp. Alkaline phosphatase. Accessed July 28, 2021. https://www.labcorp.com/tests/001107/alkaline-phosphatase# 5. ARUP Laboratories. Alkaline phosphatase isoenzymes, serum or plasma. Accessed July 28, 2021. https://ltd.aruplab.com/Tests/Pub/0021020
Case Study:
Identifying and Diagnosing HPP.
Case Study: Identifying and Diagnosing HPP
11-year-old boy referred to a pediatric endocrinologist for weakness and developmental delays.
Hypothetical patient case.
History of dental abscesses, delayed walking, and missed multiple motor milestones
Has been behind peers in motor milestones and stature; struggles to keep up with peers in physical activities
Type 2 diabetes and hypertension (father)
None
(L) = low.
*Age- and sex-adjusted normal range for 10 to <13 years, male, 141-460 U/L.1
Check with your lab for their appropriate age and sex-adjusted reference range.
Reference: 1. Colantonio DA, et al. Clin Chem. 2012;58(5):854-868. doi: 10.1373/clinchem.2011.177741
Case Study:
Identifying and Diagnosing HPP.
Case Study: Identifying and Diagnosing HPP.
7-year-old girl seeing a pediatric endocrinologist for short stature and fatigue.
Hypothetical patient case.
History of atraumatic tooth loss at 3 years of age, slight delay in meeting walking milestones, recent bout with streptococcal pharyngitis, treated with antibiotics.
Lives with mother, father, and older brother
Mother and father are both below-average height
None currently
(L) = low.
*Age- and sex-adjusted normal range for adults, 1 to {"<"}10 years, female, 156-369 U/L.1
Check with your lab for their appropriate age- and sex-adjusted reference range.
Reference: 1. Colantonio DA, et al. Clin Chem. 2012;58(5):854-868. doi: 10.1373/clinchem.2011.177741
While high ALP levels typically raise red flags, low ALP levels are often overlooked.
*Check with your lab for their appropriate age- and sex-adjusted reference range.
NOTE: Graph adapted from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) project. CALIPER samples from 1072 male and 1116 female participants (newborn to 18 years) were used to calculate age- and sex-specific reference intervals. No variation in ALP based on ethnic differences was observed.1
References: 1. Colantonio DA, et al. Clin Chem. 2012;58(5):854-868. doi: 10.1373/clinchem.2011.177741 2. Adeli K, et al. Clin Chem. 2015;61(8):1049-1062. doi:10.1373/clinchem.2015.240515 3. Schumann G, et al. Clin Chem Lab Med. 2011;49(9):1439-1446. doi:10.1515/CCLM.2011.621 4. Quest Diagnostics. Alkaline phosphatase. Accessed August 31, 2021. https://testdirectory.questdiagnostics.com/test/test-detail/234/alkaline-phosphatase?cc=MASTER 5. Labcorp. Alkaline phosphatase. Accessed August 31, 2021. https://www.labcorp.com/tests/001107/alkaline-phosphatase 6. ARUP Laboratories. Alkaline phosphatase isoenzymes, serum or plasma. Accessed August 31, 2021. https://ltd.aruplab.com/Tests/Pub/0021020