ALKALINE PHOSPHATASE ELEVATION
Ask the following questions:
- What is the calcium level? If this is increased, one should look for primary hyperparathyroidism and bone metastasis. These two findings can be further differentiated with parathyroid hormone (PTH) assay. If calcium is decreased, the patient may have vitamin D deficiency, malabsorption syndrome, Fanconi's syndrome, or other renal diseases.
- Are there abnormalities of liver function tests? If the calcium is normal but liver function tests are abnormal, think of liver disease, obstructive jaundice, and liver metastasis. If the patient is not pregnant, sepsis, Paget's disease, osteogenic sarcoma, gynecologic malignancies, and liver and bone metastasis may be considered.
- What is the phosphate level? In the face of a low calcium level, a low phosphate level will help distinguish vitamin D deficiency, malabsorption syndrome, and Fanconi's syndrome from other renal diseases in which the phosphate level will be high.
- Is there a high 5'-nucleotidase or
γ
-glutamyltransferase level? This will help distinguish liver disease from Paget's disease, metastatic bone disease, and osteogenic sarcoma.
DIAGNOSTIC WORKUP
The workup should include a CBC, sedimentation rate, urinalysis, chemistry panel, protein electrophoresis, liver profile, PTH assay, skeletal survey, bone scan, CT scan of the abdomen, alkaline phosphatase isoenzymes, acid phosphatase, and a PSA to rule out prostatic carcinoma.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
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ASPARTATE AMINOTRANSFERASE ELEVATION (Algorithmic Diagnosis of Symptoms and Signs)
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