med j west black sea Medical Journal of Western Black Sea 2822-4302 2587-0602 Zonguldak Bulent Ecevit University Health Care Administration Sağlık Kurumları Yönetimi Atipik İzoenzim Paternli Benign Geçici Hiperfosfatazemi Olgu Sunumu Benign Transient Hyperphosphatasemia with Atypical İsoenzyme Pattern: A Case Report https://orcid.org/0000-0002-0373-9615 Girgeç Ahmet KAHRAMANMARAŞ HEALTH ACADEMY 12 31 2019 3 3 114 118 03 29 2019 12 31 2019 Copyright © 2017, Medical Journal of Western Black Sea 2017 Medical Journal of Western Black Sea

Alkalen fosfataz özellikle ergenlik döneminde artmış büyüme hızınedeniyle ve gebelik döneminde ise fetal ve plesental yapılarınüretimindeki artıştan dolayı 2- 3 kat artabilir. Fakat hayatın hiçbirdöneminde benign geçici hiperfosfatazemideki kadar artmaz. Benigngeçici hiperfosfatazemi (BGH), sıklıkla 5 yaşından küçükçocuklarda serum alkalen fosfataz düzeyinin (ALP) normaldeğerlerin 3–50 kata kadar yüksekliği ile seyreden ve ALP’ninhaftalar veya aylar içinde normale döndüğü benign bir klinikdurumdur. Bu hastalıkta genellikle karaciğer ve kemik kaynaklı ALPizoenzimleri yükselir, ince barsak izoenzimlerin yükseldiği daha azgörülmüştür. ALP yüksekliği ile başvuran hastalarda karaciğer,kemik hastalıkları ve maligniteler ekarte edildikten sonra benigngeçici hiperfosfatazemi tanıda akla gelmelidir. Bu yazıda bulantıkusma nedeniyle takip edilen ve bakılan tetkiklerinde rastlantısalolarak ALP düzeyinin normalin 20 katı kadar yüksek olan ve diğerhastalıklar ekarte edilerek BGH tanısı konulan15 aylık kız hastayıliteratürdeki bilgiler eşliğinde paylaşmak istedik.

Alkaline phosphatase (ALP) can increase by 2-3 times due to theincrease in the production of fetal and plasental structures duringpregrancy, especially due to the increased growth rate duringadolescence. But in any period of life it never increases as much asBenign Transient Hyperphosphatasemia (BTH). BTH is a benignclinical condition in which serum alkaline phosphatase elevates 3-50times higher than the normal rates in children under 5 years old. Inthis disease liver and bone derived ALP izoenzymes usually rise,small intestines’ rise less. For patients with elevated ALP, afterexcluding liver and bone diseases and malignancies, for diagnosisand differantial diagnosis benign transient hyperphosphatasemiashould be taken into consideration.In this article, we would like topresent that; 15 month-old girl patient who is followed up nuasea andvomiting, incedentally during the follow up ALP value was found 20times higher than the normal value of a patient in the same age groupwith in information of literatüre.

 Çocukluk çağında Alkalen Fosfataz Yüksekliği Benign geçici hiperfosfatazemi KAYNAKLAR: Referans1. Huh SY, Feldman HA, Cox JE, Gordon CM. Prevalence of transient hyperphosphatasemiaamonghealthyinfantsandtoddlers. Pediatrics 2009;124:703-9. 2.Teitelbaum JE, Laskowski A, Barrows FP. Benign transient hyperphosphatasemia in infantsandchildren: A prospectivecohort. J Pediatr EndocrinolMetab 2011;24:93-5. Referans3. Candemir M, Özdemir MA, Ergin H. Bir vaka nedeniyle selim ge¬çici hiperfosfatazemi. Fırat Tıp Derg 2008;13:74-6. Referans4. Tolaymat N, de Melo MC. Benigntransienthyperphosphatasemia of infancyandchildhood. South Med J 2000;93:1162-4. Referans5. Eymann A, Cacchiarelli N, Alonso G, Llera J. Benigntransient hyperphosphatasemia of infancy. A commonbenignscenario, abigconcernfor a pediatrician. J Pediatr EndocrinolMetab2010;23:927-30 Referans6.Arıkan Ç, Arslan M, Tümgör G, Çakır M, Aydoğdu S. Çocukluk çağı benign geçici hiperfostazemisi. Güncel Pediat 2007;5:96-8. Referans7. Posen S, Lee C, Vines R, et al. Transienthyperphosphatasemia of infancy--an insufficientlyrecognizedsyndrome. ClinChem 1977;23:292-4. Referans8. Kraut JR, Metrick M, Maxwell NR, Kaplan MM. Isoenzymestudies in transienthyperphosphatasemia of infancy. Ten newcasesand a review of theliterature. Am J Dis Child 1985;139:736-40. Referans9. Kutilek S, Cervickova B, Bebova P, Kmonickova M, Nemec V. Nor¬mal bone turnover in transienthyperphosphatasemi. J ClinRes Pediatr En docrinol 2012;4:154-6. Referans10. Eboriadou M, Skouli G, Panagopoulou P, Haidopoulou K, MakedouA, Varlamis G. Acute laryngotracheobronchitis and associated transienthyperphosphatasemia: A newcase of transient hyperphosphatasemia in earlychildhood. J Paediatr Child Health2006;42:149-50. Referans11. Suzuki M, Okazaki T, Nagai T, Törõ K, Sétonyi P. Viralinfection of infantsandchildren with benign transien thyperphosphatasemia.FEMS ImmunolMedMicrobiol 2002;33:215-8. Referans12. Crofton PM. What is thecause of benigntransienthyperphosphatasemia? A study of 35 cases. ClinChem 1988;34:335-40. Referans13. Asanti R, Hultin H, Visakorpi JK. Serum alkaline, phosphatase in healthyinfants. Occurrence of abnormallyhighvalueswithoutknowncause. AnnPaediatrFenn 1966;12:139-42. Referans14. Carrol AJ andCoakley JC. Transienthyperphosphatasaemia: An important condition torecognize. J Paediatr Child Health2001;37:359-362. Referans15. Behulova D, Bzduch V, Holesova D, Vasilenkova A, Ponec J.Transient hyperphosphatasemia of infancyandchildhood:study of 194 cases. ClinChem2000;46:1868-1869. Referans16. Otero JL, Gonzalez-Peralta RP, Andres JM, et al. Elevated Alkali¬ne Phosphatase in Children: An AlgorithmtoDetermineWhen a “WaitandSee” Approach is Optimal. ClinMedInsights Pediatr 2011;5:15-8. Referans17. Antoniades K, Karakasis D, Kapetanos G, Lasaridis N,Tzarou V. Chronic idiopathic hyperphosphatasemia. Case report. Oral Surg Oral Med Oral Pathol1993;76:200-204. Referans18. Dundar B, Turedi A, Comak E. Selim gecicihiperfosfatazemili bir vaka. Çocuk Dergisi 2005;5:66-67. Referans19. Siraganian PA, Mulvihill JJ, Mulivor RA, Miller RW. Benign familialhyperphosphatasemia. JAMA 1989;261:1310-1312.