This article discusses the most

This article discusses the most common causes of raised alkaline phosphatase levels in an asymptomatic patient and provides advice on the relevant investigations.Learning pointsIf alkaline phosphatase is raised in an asymptomatic patient and serum bilirubin, liver transaminases, creatinine, adjusted calcium, thyroid function, and blood count are normal:Consider growth spurts in adolescents, pregnancy in women, drugs, and age related increasesAs most likely sources are either bone or liver, differentiate by measuring glutamyltransferase (raised in liver) and investigate accordinglyFor liver cases investigate with abdominal ultrasound scan (cholestasis and hepatic space occupying lesion) and antimitochondrial antibodies (primary biliary cirrhosis)For bone cases investigate vitamin DA 51 year old asymptomatic woman presented to her general practitioner for cascade screening for familial hypercholesterolaemia. Blood tests revealed a normal full blood count, renal function, thyroid function, lipid profile, glucose levels, bone profile, and liver profile except for an isolated increased alkaline phosphatase (ALP) concentration at 171 U/L (reference interval 30 130).What is the next investigation?ALP is found in high concentrations in liver, bone, kidney, intestine, and placenta. In adults, circulating ALP is predominantly of hepatic and bony origin.

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