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Failure to Thrive in Children With Hyperphosphatasia-Reply

JEROME R. KRAUT, MD
Am J Dis Child. 1986;140(5):408-409. doi:10.1001/archpedi.1986.02140190018007.
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In Reply.—This letter is in response to the letter you received from Dr Goldstein of the Indiana University School of Medicine, Indianapolis. He wrote you regarding my article on "Isoenzyme Studies in Transient Hyperphosphatasemia of Infancy."1

Dr Goldstein's suggestion was that the marked elevation of alkaline phosphatase may be due to bone resorption and/or liver degeneration secondary to acute severe malnutrition. This seems to be a very unlikely explanation in view of the fact that of the children with this syndrome who have had bone x-ray films, no abnormalities have been noted. In addition, vitamin D studies, although not done very frequently, have yielded normal results. Likewise, in those patients who have had extensive studies of the liver, ie, ultrasound, no abnormalities have been noted. It would seem that if the cause for marked elevation of alkaline phosphatase was bone resorption and liver degeneration secondary to malnutrition, more

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