Elevated alkaline phosphatase is a condition where the levels of alkaline phosphatase

Alkaline phosphatase

Alkaline phosphatase is a hydrolase enzyme responsible for removing phosphate groups from many types of molecules, including nucleotides, proteins, and alkaloids. The process of removing the phosphate group is called dephosphorylation...

 exceed that found in a reference range. It can be associated with certain medical conditions. or syndromes (e.g. Hyperphosphatasia with mental retardation syndrome

Hyperphosphatasia with mental retardation syndrome

Hyperphosphatasia with Mental retardation syndrome, HPMRS , also known as Mabry syndrome, has been described in patients recruited on four continents world-wide...

, HPMRS)

If it is unclear why alkaline phosphatase is elevated, isoenzyme studies using electrophoresis

Electrophoresis

Electrophoresis, also called cataphoresis, is the motion of dispersed particles relative to a fluid under the influence of a spatially uniform electric field. This electrokinetic phenomenon was observed for the first time in 1807 by Reuss , who noticed that the application of a constant electric...

 can confirm the source of the ALP. Heat stability also distinguishes bone and liver isoenzymes ("bone burns, liver lasts").

Liver

• Liver
  Liver
  The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
  
   (Liver ALP):
  • Cholestasis
    Cholestasis
    In medicine, cholestasis is a condition where bile cannot flow from the liver to the duodenum. The two basic distinctions are an obstructive type of cholestasis where there is a mechanical blockage in the duct system such as can occur from a gallstone or malignancy and metabolic types of...
    
    , cholecystitis
    Cholecystitis
    -Signs and symptoms:Cholecystitis usually presents as a pain in the right upper quadrant. This is known as biliary colic. This is initially intermittent, but later usually presents as a constant, severe pain. During the initial stages, the pain may be felt in an area totally separate from the site...
    
    , cholangitis, cirrhosis
    Cirrhosis
    Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules , leading to loss of liver function...
    
    , hepatitis
    Hepatitis
    Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
    
    , fatty liver
    Fatty liver
    Fatty liver, also known as fatty liver disease , is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis...
    
    , sarcoidosis
    Sarcoidosis
    Sarcoidosis , also called sarcoid, Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, is a disease in which abnormal collections of chronic inflammatory cells form as nodules in multiple organs. The cause of sarcoidosis is unknown...
    
    , liver tumor, liver metastases, drug intoxication
    • N.B. concurrently elevated GGT (gamma glutamyl transpeptidase
      Gamma glutamyl transpeptidase
      Gamma-glutamyltransferase or gamma-glutamyl transpeptidase is an enzyme that transfers gamma-glutamyl functional groups...
      
      ) helps rule in favor of liver metastasis (rather than bone, kidney, etc.) when assessing spread of cancer.
  • Drugs
    Medication
    A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
    
    : e.g. verapamil
    Verapamil
    Verapamil is an L-type calcium channel blocker of the phenylalkylamine class. It has been used in the treatment of hypertension, angina pectoris, cardiac arrhythmia, and most recently, cluster headaches. It is also an effective preventive medication for migraine...
    
    , carbamazepine
    Carbamazepine
    Carbamazepine is an anticonvulsant and mood-stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder, as well as trigeminal neuralgia...
    
    , phenytoin
    Phenytoin
    Phenytoin sodium is a commonly used antiepileptic. Phenytoin acts to suppress the abnormal brain activity seen in seizure by reducing electrical conductance among brain cells by stabilizing the inactive state of voltage-gated sodium channels...
    
    , erythromycin
    Erythromycin
    Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
    
    , allopurinol
    Allopurinol
    Allopurinol is a drug used primarily to treat hyperuricemia and its complications, including chronic gout.- Mechanism of action :...
    
    , ranitidine
    Ranitidine
    Ranitidine is a histamine H2-receptor antagonist that inhibits stomach acid production. It is commonly used in treatment of peptic ulcer disease and gastroesophageal reflux disease . Ranitidine is also used alongside fexofenadine and other antihistamines for the treatment of skin conditions...
    
    

Bone/skeletal

• Bone
  Bone
  Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
  
   disease (Bone ALP):
  • Paget's disease
    Paget's disease of bone
    Paget's disease is a chronic disorder that can result in enlarged and misshapen bones. The excessive breakdown and formation of bone tissue causes affected bone to weaken, resulting in pain, misshapen bones, fractures, and arthritis in the joints near the affected bones...
    
    , osteosarcoma
    Osteosarcoma
    Osteosarcoma is an aggressive cancerous neoplasm arising from primitive transformed cells of mesenchymal origin that exhibit osteoblastic differentiation and produce malignant osteoid...
    
    , bone metastases of prostatic cancer (High / very high ALP values)
  • Other bone metastases
  • Renal osteodystrophy
    Renal osteodystrophy
    Renal osteodystrophy or chronic kidney disease-mineral and bone disorder is a bone pathology, characterized by bone mineralization deficiency, that is a direct result of the electrolyte and endocrine derangements that accompany chronic kidney disease...
    
    
  • Fractured bone
  • Multiple myeloma
    Multiple myeloma
    Multiple myeloma , also known as plasma cell myeloma or Kahler's disease , is a cancer of plasma cells, a type of white blood cell normally responsible for the production of antibodies...
    
     (only when associated with fractures)

• Skeletal involvement of other primary diseases:
  • Osteomalacia
    Osteomalacia
    Osteomalacia is the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone as a result of hyperparathyroidism...
    
    , rickets
    Rickets
    Rickets is a softening of bones in children due to deficiency or impaired metabolism of vitamin D, magnesium , phosphorus or calcium, potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries...
    
    , vitamin D deficiency, (Moderate rise)
  • Malignant tumors (ALP originating from tumor)
  • Renal disease (secondary hyperparathyroidism
    Hyperparathyroidism
    Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone . The parathyroid hormone regulates calcium and phosphate levels and helps to maintain these levels...
    
    )
  • Primary hypothyroidism
    Hypothyroidism
    Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
    
    

Cancer

As carcino-placental alkaline phosphatase (Reagan's isoenzyme)

• Breast carcinoma
• Colon cancer
• Hodgkin lymphoma

Other

• Lung cancer
  Lung cancer
  Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
  
  
• Chlorpropamide
  Chlorpropamide
  Chlorpropamide is a drug in the sulphonylurea class used to treat type 2 diabetes mellitus. It is a long-acting sulphonylurea. It has more side effects than other sulphonylureas and its use is no longer recommended.-Mechanism of action:...
  
   therapy
• Infectious mononucleosis
  Infectious mononucleosis
  Infectious mononucleosis is an infectious, widespread viral...
  
  
• Pancreatic carcinoma
• Polycythemia vera
  Polycythemia vera
  Polycythemia vera is a blood disorder in which the bone marrow makes too many red blood cells. It may also result in the overproduction of white blood cells and platelets. Most of the health concerns associated with polycythemia vera are caused by the blood being thicker as a result of the...
  
  
• Myelofibrosis
  Myelofibrosis
  Myelofibrosis, also known as myeloid metaplasia, chronic idiopathic myelofibrosis, osteomyelofibrosis and primary myelofibrosis is a disorder of the bone marrow...
  
  
• Leukemoid reaction
  Leukemoid reaction
  The term leukemoid reaction describes an elevated white blood cell count, or leukocytosis, that is a physiological response to stress or infection .It may be lymphoid or myeloid....
  
   to infection
• Women using hormonal contraception
  Hormonal contraception
  Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive...
  
  
• Pregnancy
  Pregnancy
  Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
  
  
• Transient hyperphosphatasaemia of infancy: benign
  Benign
  A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
  
  , often associated with infection
• Seminoma