Non-hepatic cause of elevated alkaline phosphatase
GGT is normal in non-hepatic causes.
| Physiological | Pregnancy Adolescence Following a fatty meal in subjects with blood group O or B |
| Bone disease | Healing Fracture Paget’s Disease Osteomalacia Vitamin D insufficiency Rickets Malignancy: osteogenic sarcoma, bone metastases |
| Renal | Renal Failure |
| Heart | Heart Failure |
| Endocrine | Hyperthyroidism Hyperparathyroidism |
| Malignancy | Lymphoma Leukemia Renal cell carcinoma Multiple endocrine neoplasia (MEN) II |
Source of table: Clinics in Liver Disease. 2012;16(2):199-229.
“An elevated bone ALP is indicative of high bone turnover, which may be caused by several disorders including healing fractures, osteomalacia, hyperparathyroidism, hyperthyroidism, Paget disease of bone, osteogenic sarcoma, and bone metastases. Refer those patients to an endocrinologist for evaluation. Initial testing may include measurement of serum calcium, parathyroid hormone, 25-hydroxyvitamin D, and imaging with bone scintigraphy.” UTD
Hepatic Causes of Elevated Alkaline Phosphatase
GGT is increased as well.
- Obstructive hepatobiliary disease
- Hepatitis e.g. viral, alcoholic, toxic
- Hemochromatosis
- Infiltrative liver disease e.g. sarcoidosis, amyloidosis, lymphoma, tuberculosis.
Causes of Cholestatic Liver Disease
| INTRAHEPATIC CHOLESTASIS | EXTRAHEPATIC CHOLESTASIS |
|---|---|
| Hepatitis: Viral (B, C), Alcoholic | Extrinsic Obstruction |
| Genetic: | – stones |
| – Benign recurrent intrahepatic cholestasis | Malignancy |
| – Progressive familial intrahepatic cholestasis | – Pancreas |
| – Dubin-Johnson, Rotor’s Syndrome | – Gallbladder |
| – Drugs and herbal remedies | – Metastatic |
| Pregnancy | – Cholangiocarcinoma |
| Primary biliary cirrhosis (PBC) | – Ampullary cancer |
| Primary Sclerosing Cholangitis (PSC) | Pancreatitis |
| Granulomatous liver disease | Pancreatic pseudocyst |
| – Infections | Parasitic Infection |
| – Sarcoidosis | Secondary sclerosis (surgery, chemotherapy) |
| Infiltrative: | |
| – Amyloidosis | |
| – Lymphoma | |
| Idiopathic Adult Ductopenia | |
| Autoimmune Cholangitis (PSC-like) | |
| Autoimmune Cholangiopathy (PBC-like) | |
| Prolonged TPN | |
| Postoperative state | |
| Sepsis | |
| Malignancy | |
| – Hepatocellular | |
| – Metastatic | |
Source of table: Clinics in Liver Disease. 2012;16(2):199-229.
Reference
Approach To A Patient With Elevated Serum Alkaline Phosphatase. Clinics in Liver Disease. 2012;16(2):199-229. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341633