Published online July 20, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 703-709 (doi:10.1542/peds.2008-3093)
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ARTICLE

Prevalence of Transient Hyperphosphatasemia Among Healthy Infants and Toddlers

Susanna Y. Huh, MD, MPHa, Henry A. Feldman, PhDb, Joanne E. Cox, MD, MPHc and Catherine M. Gordon, MD, MScd,e

a Divisions of Gastroenterology
c General Pediatrics
d Adolescent Medicine
e Endocrinology
b Clinical Research Program, Children's Hospital Boston, Boston, Massachusetts

OBJECTIVE: To describe the prevalence and clinical characteristics of transient hyperphosphatasemia (TH) in a cohort of healthy infants and toddlers.

METHODS: We performed a secondary data analysis of healthy infants and toddlers enrolled in a study examining the epidemiology of vitamin D deficiency. From 2005 to 2007, children aged 8 to 24 months were enrolled during well-child visits at an urban primary care pediatric clinic. At enrollment, we collected data regarding sociodemographic and clinical characteristics. We measured serum levels of alkaline phosphatase (AP), 25-hydroxyvitamin D, parathyroid hormone (PTH), calcium, magnesium, and phosphorus. We placed participants into 1 of 3 categories on the basis of serum AP levels: normal (AP: 110–400 U/L), intermediate (AP: >400 to 1000 U/L), and TH (AP: >1000 U/L). We used Fisher's exact test and analysis of variance to evaluate differences in characteristics among the 3 groups.

RESULTS: Nine (2.8%) of 316 children had an AP level of >1000 U/L (mean: 2165 U/L). Sixteen children (5.1%) had an intermediate serum AP level (mean: 544 U/L). Mean weight-for-age, length-for-age, and weight-for-length z scores were similar across all 3 AP groups. Compared with the 291 children without TH, children in the intermediate AP and TH groups had similar mean serum levels of 25-hydroxyvitamin D, PTH, calcium, magnesium, and phosphorus.

CONCLUSIONS: TH seems to be a relatively common condition among healthy infants and toddlers. TH was not associated with anthropometric measures, vitamin D status, PTH, or serum minerals. Recognition of this benign condition is important to avoid unnecessary investigations.

Key Words: alkaline phosphatase • endocrinology • epidemiology

Abbreviations: TH—transient hyperphosphatasemia • AP—alkaline phosphatase • PTH—parathyroid hormone

Accepted Jan 12, 2009.


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