Tumor Induced Osteomalacia
Abstract
Tumour-induced osteomalacia (TIO) is a rare paraneoplastic disorder caused by fibroblast growth factor 23 (FGF23) secreting from tumor that is resulting by hypophosphatemia from decreased tubular phosphate reabsorption, with a low or inappropriately normal level of active vitamin D. Chronic hypophosphatemia can eventually lead to inadequate bone mineralization, presenting as osteomalacia. The diagnosis of TIO is usually suspected when serum phosphate levels are chronically low in the setting of bone pain, fragility fractures and muscle weakness. The only definite treatment is surgical removal of the tumour. Localization of responsible tumors could be rather difficult since the vast majority are very small and could be everywhere in the body. A combination of physical examination, laboratory tests and imaging techniques should be applied. For those undetectable or unresectable cases, phosphate supplements and active vitamin D should be administrated and curative intended radiotherapy or ablation are optional.
Keywords: Tumor-induced osteomalacia, Fibroblast growth factor 23, hypophosphatemia, Treatment
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