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Tumor-induced osteomalacia.
- Source :
-
Endocrine-related cancer [Endocr Relat Cancer] 2011 Jun 08; Vol. 18 (3), pp. R53-77. Date of Electronic Publication: 2011 Jun 08 (Print Publication: 2011). - Publication Year :
- 2011
-
Abstract
- Tumor-induced osteomalacia (TIO) is a rare and fascinating paraneoplastic syndrome in which patients present with bone pain, fractures, and muscle weakness. The cause is high blood levels of the recently identified phosphate and vitamin D-regulating hormone, fibroblast growth factor 23 (FGF23). In TIO, FGF23 is secreted by mesenchymal tumors that are usually benign, but are typically very small and difficult to locate. FGF23 acts primarily at the renal tubule and impairs phosphate reabsorption and 1α-hydroxylation of 25-hydroxyvitamin D, leading to hypophosphatemia and low levels of 1,25-dihydroxy vitamin D. A step-wise approach utilizing functional imaging (F-18 fluorodeoxyglucose positron emission tomography and octreotide scintigraphy) followed by anatomical imaging (computed tomography and/or magnetic resonance imaging), and, if needed, selective venous sampling with measurement of FGF23 is usually successful in locating the tumors. For tumors that cannot be located, medical treatment with phosphate supplements and active vitamin D (calcitriol or alphacalcidiol) is usually successful; however, the medical regimen can be cumbersome and associated with complications. This review summarizes the current understanding of the pathophysiology of the disease and provides guidance in evaluating and treating these patients. Novel imaging modalities and medical treatments, which hold promise for the future, are also reviewed.
- Subjects :
- Algorithms
Animals
Diagnosis, Differential
Fibroblast Growth Factor-23
Fibroblast Growth Factors blood
Fibroblast Growth Factors metabolism
Fibroblast Growth Factors physiology
Humans
Neoplasms complications
Neoplasms pathology
Neoplasms therapy
Neoplasms, Connective Tissue pathology
Osteomalacia diagnosis
Osteomalacia etiology
Osteomalacia pathology
Osteomalacia therapy
Paraneoplastic Syndromes
Phosphates metabolism
Phosphates physiology
Neoplasms, Connective Tissue diagnosis
Neoplasms, Connective Tissue etiology
Neoplasms, Connective Tissue therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1479-6821
- Volume :
- 18
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Endocrine-related cancer
- Publication Type :
- Academic Journal
- Accession number :
- 21490240
- Full Text :
- https://doi.org/10.1530/ERC-11-0006