scholarly journals A misleading case of elevated alkaline phosphatase in alcoholic liver disease: Paget’s disease of the bone

2019 ◽  
Vol 28 (4) ◽  
pp. 514-514
Author(s):  
Stefan Lucian Popa ◽  
Liliana David ◽  
George Ionut Golea
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Elevated Alkaline Phosphatase

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scholarly journals MON-349 Left Hip Pseudofracture in a Patient with Refractory Paget Disease of the Bone

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alheli Arce Gastelum ◽  
Anusha Pinjala ◽  
Sima Maraqa ◽  
Megan Block ◽  
Mohsen Zena
Keyword(s):  
Alkaline Phosphatase ◽  
Zoledronic Acid ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Hip Pain ◽  
Normal Heart ◽  
Elevated Alkaline Phosphatase ◽  
Left Femur ◽  
Benign Condition ◽  
X Ray

Abstract Background Paget’s disease of the Bone (PDB) is a benign condition caused by focal abnormal bone remodeling. It is largely asymptomatic and is often discovered incidentally while investigating an elevated alkaline phosphatase (ALP) or imaging studies. Diagnosis relies on biochemical screening, ALP, as a first line test. X-rays and radionuclide scans can assist in determining the extent of disease. Bisphosphonates are recommended for the treatment of bone pain associated with PDB. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response. Treatment aimed at improving symptoms is recommended over a treat-to-target strategy aimed at normalizing total ALP in PDB. Clinical case A 51-year-old, non-verbal female presented to the Endocrinology office with her legal guardian for a follow-up regarding Paget’s disease of the bone. The patient had a past medical history of mental disability and refractory Paget’s disease that was diagnosed 13 years prior in the setting of elevated alkaline phosphatase. At the time of diagnosis bone scan showed involvement of both tibias, pelvis and right femur stress fracture. She also had a right femoral fracture 7 years before the current presentation that was surgically fixed with an intramedullary rod. The patient had undergone 5 yearly infusions of Zoledronic acid with persistent elevated alkaline phosphatase. During her clinic visit the patient endorsed left non-traumatic hip pain as well as difficulty walking over the last 2 weeks. Vital signs were within normal limits. On physical exam she appeared well developed, no acute distress was noted, normal heart rate, regular rhythm and normal heart sounds. Pulmonary effort was normal, no respiratory distress or abnormal sounds were appreciated. Musculoskeletal exhibited bilateral lower extremity bowing. No skin warmth, bony growths or tenderness on palpation were noted. Lab work revealed ALP 277 u/l, bone specific alkaline phosphatase 95.9 (8.1 - 31.6), BUN 12 mg/dl, Creatinine 0.66 mg/dl, GFR 90, Calcium 9.0 mg/dl, Vitamin D 23.3 ng/mL. She had been treating the hip pain with as needed NSAIDs. An X-ray of the left femur was ordered, and the study showed possible acute subcapital minimally displaced femoral neck fracture with minimal impaction in the setting of known Paget’s disease. The patient was then contacted and asked to present to the ER emergently for further evaluation and treatment. Upon arrival to the Emergency Department, an MRI of the left hip was performed, demonstrating extensive Paget’s disease with no evidence of acute hip fracture. Conclusions It is essential to obtain an urgent x-ray in patients with Paget’s disease who presents with localized pain. However as this case demonstrates x-ray findings can be misleading due to underlying structural deformity of the bone and further imaging like CT or MRI may be necessary.

Paget’s disease: clinical update

2011 ◽  
Vol 152 (33) ◽  
pp. 1337-1346
Author(s):  
Judit Donáth ◽  
Gyula Poór
Keyword(s):  
Alkaline Phosphatase ◽  
Serum Alkaline Phosphatase ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Etiologic Role ◽  
Osteoblast Activity ◽  
Chronic Disorder ◽  
Abnormal Increase ◽  
Osteoclast Function ◽  
High Level

Paget’s disease is a chronic disorder of bone remodeling, characterized by an abnormal increase of osteoclast and, hence, osteoblast activity. The imbalance of bone turnover results in the formation of unhealthy and fragile bone. It also leads to impairment of adjacent joints and to a risk of various complications. Current research focuses on the elucidation of the etiologic role viral infection and predisposing genetic factors. Paget’s disease is commonly discovered by chance; its suspicion is raised either by high level of alkaline phosphatase or by the X-ray of the pathological bone. Bisphosphonates have proven to be effective in controlling disease activity because they inhibit osteoclast function. Their use is recommended when bone-derived serum alkaline phosphatase is high and/or when disease localizations are highly suspected for the development of complications. Orv. Hetil., 2011, 152, 1337–1346.

Skeletal Blood Flow in Paget's Disease of Bone and its Response to Calcitonin Therapy

1978 ◽  
Vol 54 (1) ◽  
pp. 69-74 ◽  
Author(s):  
R. Wootton ◽  
J. Reeve ◽  
E. Spellacy ◽  
M. Tellez-Yudilevich
Keyword(s):  
Alkaline Phosphatase ◽  
Blood Flow ◽  
Serum Alkaline Phosphatase ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Short Term ◽  
Urinary Hydroxyproline ◽  
Rapid Fall ◽  
Hydroxyproline Excretion

1. Blood flow to the skeleton was measured by the 18F clearance method of Wootton, Reeve & Veall (1976) in 24 patients with untreated Paget's disease. In every patient but one, resting skeletal blood flow was increased. There was a significant positive correlation between skeletal blood flow and serum alkaline phosphatase and between skeletal blood flow and urinary total hydroxyproline excretion. 2. Fourteen patients were re-studied after they had received short-term (7 days or less) or long-term (7 weeks or more) calcitonin. Skeletal blood flow, alkaline phosphatase and urinary hydroxyproline excretion fell towards normal in every case. There was some evidence from the short-term studies that calcitonin produced a more rapid fall in skeletal blood flow than in alkaline phosphatase. 3. Glomerular filtration rate appeared to increase transiently in response to calcitonin.

Plasma Calcitonin in Paget's Disease of Bone

1977 ◽  
Vol 52 (3) ◽  
pp. 329-332 ◽  
Author(s):  
J. A. Kanis ◽  
G. Heynen ◽  
R. J. Walton
Keyword(s):  
Alkaline Phosphatase ◽  
Plasma Levels ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Paget's Disease Of Bone ◽  
Control Subjects ◽  
Plasma Alkaline Phosphatase ◽  
And Control ◽  
Age And Sex

1. Plasma levels of immunoreactive calcitonin were measured in 22 patients with untreated Paget's disease of bone and in 22 control subjects matched for age and sex. 2. No significant differences in plasma calcitonin were found between patients and control subjects, and hormone levels did not correlate significantly with activity of plasma alkaline phosphatase. 3. These results suggest that Paget's disease of bone is not due to deficient secretion of endogenous calcitonin.

Alcoholic liver disease presenting with marked elevation of serum alkaline phosphatase

1978 ◽  
Vol 23 (12) ◽  
pp. 1061-1066 ◽  
Author(s):  
Robert P. Perrillo ◽  
Ronald Griffin ◽  
Katherine DeSchryver-Kecskemeti ◽  
Jerrold J. Lander ◽  
Gary R. Zuckerman
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Serum Alkaline Phosphatase ◽  
Marked Elevation

scholarly journals Evaluation of Serum Zinc Status and Serum Alkaline Phosphatase Activity in Alcoholic Liver Disease Patients - A Hospital Based Study from Chennai, Tamil Nadu

2021 ◽  
Vol 8 (24) ◽  
pp. 2100-2105
Author(s):  
Uma T ◽  
Nirmaladevi P ◽  
Shanthi R ◽  
Mahalakshmi R
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Phosphatase Activity ◽  
Alcoholic Liver Disease ◽  
Alkaline Phosphatase Activity ◽  
Serum Zinc ◽  
Meld Score ◽  
Gamma Glutamyl Transferase ◽  
Zinc Status ◽  
Glutamyl Transferase

BACKGROUND Alcoholism remains to be the major cause of morbidity and mortality throughout the world. Consuming alcohol is the potent etiological factor for the development of alcoholic liver diseases (ALD), ranging from fatty liver to hepatocellular carcinoma with varying rates of development in both genders depending on the quality, quantity, and duration of the drink. Zinc deficiency has been documented with the progression of alcoholic liver disease. It is also a well-known fact that zinc is a co-factor for enzyme alkaline phosphatase. This study aims to assess the zinc status and alkaline phosphatase activity in patients with various stages of alcoholic liver disease, correlate zinc with alkaline phosphatase activity, albumin, gamma glutamyl transferase activity, MELD score and duration of alcohol intake and analysing the need for evaluating zinc in these patients. METHODS This comparative observational study involves group I healthy controls and group II patients diagnosed to have ethanol related decompensated liver disease with or without portal hypertension for more than three years from the Department of Medical Gastroenterology, Government Medical College Hospital. 5 ml of venous blood in fasting state was collected from both groups and assayed for serum zinc, and serum alkaline phosphatase activity. The data was statistically analysed. RESULTS The study results demonstrate that higher percentage of patients with alcoholic liver disease have low serum zinc levels than healthy controls. Zinc when compared with variables like serum albumin, duration of alcohol intake, MELD score, serum gamma glutamyl transferase and alkaline phosphatase in the case and control groups were found to be statistically significant. CONCLUSIONS There is decrease in serum zinc level and increased alkaline phosphatase activity in patients with alcoholic liver disease. The statistically significant data is a strong rationale for evaluating the zinc status and thereby supplementing zinc to patients with alcoholic liver disease. KEYWORDS Alcoholic Liver Disease, Zinc, Alkaline Phosphatase, MELD Score

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