The relationship of serum alkaline phosphatase levels to stages of pubic hair development

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The need to evaluate the significance of serum alkaline phosphatase (AP) values in children and adolescents occurs frequently now that automated multichannel blood analyzing equipment is so widely available. Serum AP is higher in children than in adults, and during adolescence it achieves adult levels.1 The AP is osteoblastic in origin,2 so it is not surprising that in children the AP level parallels the growth velocity,1 as calculated by the change in height in 6 months. Tanner3 has shown that secondary sex characteristics appear at different ages and take different lengths of time to develop to the adult state. Pubic hair growth, both in age of onset and duration of development, is the characteristic which most closely parallels the occurrence of the growth spurt and subsequent decline in growth velocity. We therefore set out to see if there is a relationship between the serum AP levels and the stages of pubic hair development in normal prepubertal and pubertal children, hoping this would aid the clinician in evaluating AP levels which are high by adult standards.


We studied 200 patients, ages 8 to 18 years, who attended the Cleveland Clinic outpatient department or who were admitted to the Cleveland Clinic Hospital between July 1974 and July 1975. Excluded from the study were patients who had disorders related to liver, kidney, or bone; inflammatory bowel disease; malignancy; endocrine disorders; or who were taking medication for seizures because of possible abnormal AP elevations in these conditions.4, 5 Each patient was examined by



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