Alkaline phosphatase is elevated in all except:

Ans. D: Pernicious anemia Normal physiologic elevation - Age: increased values in first 3 months of life and at pubey, normal values in women by 18 years in men by 20 years. - Sex: between age 20 and 50 years men are 20% higher than women, after menopause women are higher - Hormonal status: increased values in pubey, pregnancy (placental isoenzyme), and postmenopause - Blood type: type 0 and B associated with elevation in intestinal isoenzyme, type AB with intermediate values - Factors Associated with Elevation: Tobacco use, increased blood sugars, increasing weight, decreasing height. Pathologic elevation Hepatobiliary disease: biliary obstruction due to stones, stricture, tumor; Autoimmune: primary biliary cirrhosis, sclerosing cholangitis; infiltrative granulomatous hepatitis, fatty liver, amyloidosis, sarcoidosis, malignancy; medications: estrogen, chlorpromazine, erythromycin; viral hepatitis Bone disease: Paget disease, osteomalacia, hyperparathyroidism, metastatic bone disease, Vitamin D deficiency, recent trauma or fracture. Other causes: resolution phase of myocardial infarction, pulmonary, renal, gastrointestinal, or splenic infarction; ulceration in gastrointestinal tract; congestive hea failure with hepatic congestion; autosomal dominant familial inheritance; transient hyperphosphatemia of infancy; bronchogenic, breast, colon, ovarian, cervical, or prostate cancer; metastatic carcinoma to pleural surfaces