atherogenic milieu, possibly an alternative cause for elevated serum alkaline phosphatase. Chronic kidney disease Cancer Elevated alkaline phosphatase in patients with cancer normally spans throughout the bones or liver. Metastases that exist in the lung, breast, prostate, colon, thyroid, and further organs can also enter the liver or bone. Cancers that are already present in certain organs and tissues can produce alkaline phosphatase elevations if metastasis is not present. In experiential studies, isoenzymes, which are distinct forms of alkaline phosphatase generated by these tumors, can raise the total volume of alkaline phosphatase in the blood. The Regan isoenzyme is one of the best studies of these isoenzymes that is linked to several human cancers. Basically, the Regan isozenzyme is an alkaline phosphatase that is located in the placenta and associated with gonadal and urologic cancers. Breast carcinoma Colon cancer Leukemia – cancer of the bone marrow Lymphoma – cancer of the white blood cells Pancreatic cancer Lung cancer Diagnosis An alkaline phosphatase isoenzyme test can be done to check for elevated ALP levels. Tissues that contain high levels of ALP include the liver, bile ducts, and bones. Normal levels of ALP range from (44 to 147) U/L (units per liter) and significantly elevated levels may be an indication of conditions such as various types of cancer, bone diseases such as Paget disease, liver diseases such as hepatitis, blood disorders, or other conditions. Elevated alkaline phosphatase is most commonly caused by liver disease or bone disorders. Testing for ALP primarily consists of obtaining a blood sample from a patient along with several other tests for the disorder in question that may be associated with the increase in ALP in the blood serum. It is possible to distinguish between the different forms (isoenzymes) of ALP produced by different types of body tissues, in order to identify the cause of elevated ALP; this can facilitate choosing a treatment course. Normally, children and adolescents have higher alkaline phosphatase levels than adults, due to accelerated bone growth. ALP is especially high during the pubertal growth spurt. Other causes Infectious mononucleosis Primary sclerosing cholangitis Polycythemia vera Myelofibrosis Mastocytosis Leukemoid reaction to infection Women using hormonal contraception Pregnancy Herpes zoster (shingles) Rickets – vitamin D deficiency Amyloidosis Granulation tissue Gastrointestinal inflammation – inflammatory bowel disease (ulcerative colitis, Crohn’s disease) or ulcers) Rheumatoid arthritis Ankylosing Spondylitis Transient hyperphosphatasaemia of infancy: benign, transient, often associated with infection Seminoma Celiac