SAT-724 Persistently Elevated Alkaline Phosphatase in an Older Woman with a History of Breast Cancer

Abstract Disclosure: M. Fathima: None. J. Gilden: Novartis Pharmaceuticals. Introduction: Serum alkaline phosphatase (ALP) is derived predominantly from the liver and bones. Various causes of elevated alkaline phosphatase are related to liver disease (like Cirrhosis, bile duct obstruction, liver carcinoma), bone disorders (like Paget’s disease, Osteomalacia, hyperparathyroidism, Metastasis), and intestinal disorders (like inflammatory bowel disease). Sometimes increased ALP levels lead to the diagnosis of rare diseases or causes. We describe a case where the etiology of elevated alkaline phosphatase proved to be a rare cause. Case presentation: An 80-year-old female with osteopenia and a history of breast cancer, status post left lumpectomy, taking letrozole, was referred to the endocrine clinic due to elevated serum calcium and alkaline phosphatase levels, which were previously normal. On initial evaluation, differentials of hypercalcemia of malignancy and hyperparathyroidism were considered. Her lab work demonstrated: Serum calcium 10.4 (normal 8.6-10.3 mg/dL), phosphorus 3.1 (normal 2.5-4.5 mg/dl), albumin 4.4 (normal 3.5-5.7 g/dl), alkaline phosphatase 124 (normal 34-104 U/L) with normal fractioning, PTH 60.8 (normal 12-88 pg/ml), PTH related protein 12 (normal 11-20 pg/ml), and 24hr urine calcium 211 (normal 100-300 mg/24 hr). Upon further questioning, the patient reported using Viviscal hair product for hair loss since her lumpectomy. Literature review demonstrated that Viviscal could increase alkaline phosphatase in dermal papilla cells. Patient was hence advised to discontinue the product which resulted in normal alkaline phosphatase in subsequent visits. Conclusion: Our patient had no significant disease process linked to her elevated alkaline phosphatase. The data from vitro experiments, performed in a study indicated that tested hair growth promoting supplements like Viviscal can promote expression of alkaline phosphatase in dermal papilla cells [1]. Clinicians need to be aware of the possibility of an elevated serum alkaline phosphatase due to other causes, such as supplements that patients may be using. References: 1. Aleksandra Augustyniak, Helena Mc Mahon, Dietary marine-derived ingredients for stimulating hair cell cycle, Biomedicine & Pharmacotherapy, Volume 163, 2023, 114838, ISSN 0753 3322 https://doi.org/10.1016/j.biopha.2023.114838. Presentation: Saturday, July 12, 2025