Elevated alkaline phosphatase

Liver

Liver (liver ALP):

Cholestasis, cholecystitis, cholangitis, cirrhosis, primary biliary cholangitis, fatty liver, sarcoidosis, liver tumor, liver metastases, drug intoxication

Drugs: e.g. verapamil, carbamazepine, phenytoin, erythromycin, allopurinol, ranitidine

Bone/skeletal

Bone disease (bone ALP):

Paget's disease, osteosarcoma, bone metastases of prostatic cancer (High / very high ALP values)

Other bone metastases

Renal osteodystrophy

Fractured bone

Multiple myeloma (only when associated with fractures)

Skeletal involvement of other primary diseases:

Osteomalacia, rickets, vitamin D deficiency (moderate rise)

Malignant tumors (ALP originating from tumor)

Renal disease (secondary hyperparathyroidism)

Primary hypothyroidism

Other unlisted musculoskeletal conditions may also cause elevated alkaline phosphatase.

Obesity

Elevated levels of the alkaline phosphatase enzyme are reported with those who have obesity. A study reported there were higher serum levels of alkaline phosphatase in obese than in the non obese. With elevated alkaline phosphatase levels there is an increase in disproportionate intracellular fat depots and thereby releasing itself into the bloodstream. The relationship between alkaline phosphatase and obesity is still being tested.

Kidney

Elevated serum levels of alkaline phosphatase has been associated with Chronic Kidney Disease (CKD). Recently, studies have shown that elevated levels may predict mortality independent of bone metabolism factors and liver function tests in CKD. This distinction is indicated by the markers of inflammations specifically from C-reactive protein (CRP) with elevated levels of alkaline phosphatase. Hence, elevated serum alkaline phosphatase activity may be a marker for inflammation because of its association with elevated levels of CRP.

Chronic kidney disease

Cancer

Elevated alkaline phosphatase in patients with cancer normally spans throughout the bones or liver. Metastasize that exist in the lung, breast, prostate, colon, thyroid, and further organs can penetrate in the liver or bone. Yet, cancers that are already present in certain organs and tissues can produce alkaline phosphatase elevations if metastasis is not present. Isoenzymes, which are certain forms of alkaline phosphatase generated by these tumors, enlarges the total volume of alkaline phosphatase levels on experiential studies. The Regan isoenzyme is one of the best studies of these isoenzymes that is linked to several human cancers. Basically, the Regan isozenzyme is an alkaline phosphatase that is located in the placenta and associated with the gonadal and urologic cancers.

Breast carcinoma

Colon cancer

Leukemia - cancer of the bone marrow

Lymphoma

Pancreatic cancer

Lung cancer

Hodgkin's lymphoma - cancer of the white blood cells

Testing

An alkaline phosphatase isoenzyme test can be done to check for elevated ALP levels. Tissues that contain high levels of ALP include the liver, bile ducts, and bones. Normal levels of ALP range from 44 to 147 U/L (units per liter) and significantly elevated levels may be an indication of conditions such as various types of cancer, bone disease such as Paget disease, liver disease such as hepatitis, blood disorders, or other conditions.

Elevated alkaline phosphatase is most commonly caused by liver disease or bone disorders. Testing for ALP primarily consists of obtaining a blood sample from a patient along with several other tests for the disorder in question that may be associated with the increase in ALP in the blood serum. It is possible to distinguish between the different forms (isoenzymes) of ALP produced by different types of tissues in the body, in order to pinpoint what's causing the increase of ALP, in order to treat the patient for either liver disease or bone disorder. A more rapid way for testing ALP concentration is by using p-nitrophenyl phosphate as substrate. The required volume of serum is 5 cubic mm. for each testing. The sample is first incubated for 30 min. at 38 °C, in a buffered solution in the presence of p-nitrophenyl phosphate. By the action of ALP, phosphate groups are removed from the substrate and para- nitrophenol is liberated giving off a yellow color in solution which can be measured spectrophotometrically.

Other

Lung cancer

Prostate cancer

Chlorpropamide therapy

Infectious mononucleosis

Pancreatic carcinoma

Primary sclerosing cholangitis

Polycythemia vera

Myelofibrosis

Leukemoid reaction to infection

Women using hormonal contraception

Pregnancy

Herpes zoster (shingles)

Rickets - vitamin D deficiency

Amyloidosis

Granulation tissue

Gastrointestinal inflammation - inflammatory bowel disease (ulcerative colitis, Crohn’s disease) or ulcers)

Rheumatoid arthritis

Ankylosing Spondylitis

Transient hyperphosphatasaemia of infancy: benign, often associated with infection

Seminoma

Hyperthyroidism

Celiac disease

Sarcoid

Syphilis

Treatments

The following are the most common treatments of elevated alkaline phosphatase.

Treatment of the underlying condition

Once doctors identifies the cause of elevated ALP and diagnose a treatment, the levels of alkaline phosphatase fluctuates back to normal

Removal of medication - that is associated with increased levels of alkaline phosphatase

Birth control pills

Anti-inflammatory medication

Narcotic medication

Hormonal drug

Steroid

Antidepressant

Dietary changes

Include foods rich in vitamin D

Lifestyle change

Healthy diet in association with physical exercise

Exposure to sunlight which increases the production of vitamin D