Transient Hyperphosphatasemia: A Case Report

Main Article Content

Krittha Jeerawongpanich, MD


We report a case of a 2-year-3-month-old boy who had poor weight gain since 1 year of age. He had a history of difficulty eating since he was 6 months old. Vaccinations were up to date and his developmental assessment was normal. Physical examination revealed no dysmorphic features. His weight was 9.4 kilograms (< P3) and he was 82 centimeters in length (< P3). He had no rachitic rosary nor swelling of wrists or knees, no bowed legs or genu varus. He was referred to Burapha University Hospital for evaluation of failure to thrive. The laboratory investigations showed serum calcium of 10.2, phosphorus 4.5, magnesium 2.3 mg/dL and alkaline phosphatase 1,603 U/L. The x-ray on both knees and wrists showed no fraying and no flaring of the metaphyses. Serum 25-OH vitamin D and parathyroid hormone levels were 27.4 ng/mL and 24.7 pg/mL, respectively. The serum alkaline phosphatase decreased to 494 U/L. After 2 weeks of follow-up it further decreased to 185 U/L in 3 months with normal levels of calcium 9.8, phosphorus 5.3 mg/dL. The diagnosis of transient hyperphosphatasemia is crucial to avoid excessive investigations.

Article Details

How to Cite
Jeerawongpanich, MD K. Transient Hyperphosphatasemia: A Case Report. BKK Med J [Internet]. 2021 Feb. 11 [cited 2024 Apr. 13];17(1):42-5. Available from:
Case Report


Kraut JR, Metrick M, Maxwell NR, et al. Isoenzyme studies in transient hyperphosphatasemia of infancy: ten new cases and a review of the literature. Am J Dis Child 1985;139(7):736-40.

Huh SY, Feldman HA, Cox JE, et al. Prevalence of Transient Hyperphosphatasemia among Healthy Infants and Toddlers. Pediatrics 2009; 124(2):703-9.

Behúlová D, Bzdúch V, Holesová D, et al. Transient Hyperphosphatasemia of Infancy and Childhood: Study of 194 Cases. Clin Chem 2000; 46: 1868-9.

Gualco G, Lava SA, Garzoni L, et al. Transient Benign Hyperphosphatasemia. J Pediatr Gastroenterol Nutr 2013; 57(2):167-71.

Kutilek S, Cervickova B, Bebova P, et al. Normal Bone Turnover in Transient Hyperphosphatasemia. Journal of Clinical Research in Pediatric Endocrinology. 2012; 4(3): 154-6.

Suzuki M, Okazaki T, Nagai T, et al. Viral infection of infants and children with benign transient hyperphosphatasemia. FEMS Immunol Med Microbiol 2002;33(3):215-8.

Otero JL, González-Peralta RP, Andres JM, et al. Elevated Alkaline Phosphatase in Children:AnAlgorithm to Determine When a “Wait and See” Approach is Optimal. Clin Med Insights Pediatr. 2011;5:15-8.

Stein P, Rosalki SB, Foo AY, et al. Transient hyperphosphatasemia of infancy and early childhood: clinical and biochemical features of 21 cases and literature review. Clin Chem 1987; 33: 313–8.

Dursun F, Kirmizibekmez H. A case series of benign transient hyperphosphatasemia from a pediatric endocrinology reference health facility in Turkey. Pan Afr Med J 2018;30:206.

Eymann A, Cacchiarelli N, Alonso G, et al. Benign Transient Hyperphosphatasemia of Infancy. A Common Benign Scenario, a Big Concern for a Pediatrician. J Pediatr Endocrinol Metab 2010;23(9):927-30.