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Clement Olukayode Aransiola and Arinola Ipadeola

still beyond the reach of the common man. Case presentation A 62-year-old male Nigerian who has been in apparent good health was found to have markedly elevated serum alkaline phosphatase (ALP) of 1179 U/l (reference range, 40–115 U/l) ( Table 1

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Florence Gunawan, Elizabeth George, and Mark Kotowicz

.15–2.55 mmol/L), albumin 38 g/L (34–45), phosphate 1.28 mmol/L (0.8–1.5 mmol/L) and 25-hydroxy vitamin D of 102 nmol/L (50–250 nmol/L). Alkaline phosphatase (ALP) was elevated at 790 U/L (35–110 U/L), consistent with the known osteoblastic bone metastases. He

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Hans-Christof Schober, Christian Kneitz, Franziska Fieber, Kathrin Hesse, and Henry Schroeder

the use of forearm supports. X-rays revealed 11 vertebral body fractures, while scintigraphy showed fractures in both upper arms and thighs. The patient’s blood chemistry revealed elevated alkaline phosphatase levels, markedly reduced phosphate and

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Marisa M Fisher, Susanne M Cabrera, and Erik A Imel

seen in familial hypocalciuric hypercalcemia (FHH). Homozygous CASR mutations result in neonatal severe hyperparathyroidism (NSHPT), producing life-threatening hypercalcemia and extreme PTH and alkaline phosphatase elevations in the neonatal period

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Anna Casteràs, Lídia Darder, Carles Zafon, Juan Antonio Hueto, Margarita Alberola, Enric Caubet, and Jordi Mesa

that point, serum calcium level had reached a maximum of 2.82 mmol/L, phosphate remained normal, concomitant PTH was 196 pg/mL, vitamin D 13.7 ng/mL and alkaline phosphatase 150 IU/L (n.v. 30–120) ( Table 1 ) . Bone mineral density showed increasing

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Nobuhiro Miyamura, Shuhei Nishida, Mina Itasaka, Hirofumi Matsuda, Takeshi Ohtou, Yasuhiro Yamaguchi, Daisuke Inaba, Sadahiro Tamiya, and Tetsuo Nakano

32  Alkaline phosphatase (IU/L) 106–350 1529 1571 697 280  TSH (IU/mL) 0.35–4.94 0.74 – – –  GH (ng/mL) <2.47 0.37 – – –  IGF-1 (ng/mL) 87–245 82 – – –  PTH (pg/mL) 10–65 219

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Shintaro Kawai, Hiroyuki Ariyasu, Yasushi Furukawa, Reika Yamamoto, Shinsuke Uraki, Ken Takeshima, Kenji Warigaya, Yuji Nakamoto, and Takashi Akamizu

.7–11.0 Phosphate, mg/dL 1.6 2.5–4.5 BAP, IU/L 133.4 3.7–20.9 25(OH) D, ng/mL 9 15–40 Intact PTH, pg/mL 111 10–65 FGF23, pg/mL 43 10–50 %TRP, % 70.7 80–94 * ALP, alkaline phosphatase; BUN, blood

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Verena Schwetz, Felix Aberer, Claudia Stiegler, Thomas R Pieber, Barbara Obermayer-Pietsch, and Stefan Pilz

to normal levels and less substitution and treatment with spironolactone were necessary. After 12 days of fluconazole treatment, liver enzymes started rising (in total, alkaline phosphatase rose from 79 to 1293 U/l (35–105), gamma

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N Atapattu, K A C P Imalke, M Madarasinghe, A Lamahewage, and K S H de Silva

/l Calcium 2.68 mmol/l Phosphate 1.58 mmol/l Alkaline phosphatase 432 IU/l Figure 1 CT abdomen revealing 3.2×2.3×2.9 cm tumour superior to the upper pole of the right kidney. Histology revealed an adrenal medullary

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Zaina Adnan, David Nikomarov, Michal Weiler-Sagie, and Noga Roguin Maor

/dl), low blood phosphorus 2.10 mg/dL (normal range: 2.5–5 mg/dL), mild elevated alkaline phosphatase 144 U/L (normal range: 30–120 U/L), normal level of 25 hydroxyvitamin D 121 nmol/l. Quantitative determination of 1,25 dihydroxyvitamin D (1,25(OH)2D) in