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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.
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