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Vnitrni Lekarstvi 2021Tumor induced osteomalacia (TIO) is a rare paraneoplastic syndrome typically caused by small endocrine tumors that secrete fibroblast growth factor 23(FGF23). TIO is...
Tumor induced osteomalacia (TIO) is a rare paraneoplastic syndrome typically caused by small endocrine tumors that secrete fibroblast growth factor 23(FGF23). TIO is clinically characterized by progressive muskuloskeletal pain, fatigue, proximal muscle weakness, and multiple fractures that lead to long-term disability. Due to the non-specific symptoms of the disease, it may take several years for them to be properly diagnosed and treated, so it is important to better inform about this rare paraneoplastic syndrome.
Topics: Fibroblast Growth Factor-23; Fibroblast Growth Factors; Humans; Osteomalacia; Pain; Paraneoplastic Syndromes
PubMed: 35459330
DOI: No ID Found -
Reviews in Endocrine & Metabolic... Apr 2001
Review
Topics: Animals; Humans; Neoplasms; Osteomalacia
PubMed: 11705323
DOI: 10.1023/a:1010006811394 -
Bone Nov 2021Tumor-induced osteomalacia (TIO), also known as oncogenic osteomalacia, is a rare acquired paraneoplastic disease, which is challenging to diagnose and treat. TIO is... (Review)
Review
Tumor-induced osteomalacia (TIO), also known as oncogenic osteomalacia, is a rare acquired paraneoplastic disease, which is challenging to diagnose and treat. TIO is characterized by hypophosphatemia resulting from excess levels of tumor-secreted fibroblast growth factor 23 (FGF23), one of the key physiological regulators of phosphate metabolism. Elevated FGF23 results in renal phosphate wasting and compromised vitamin D activation, ultimately resulting in osteomalacia. Patients typically present with progressive and non-specific symptoms, including bone pain, multiple pathological fractures, and progressive muscle weakness. Diagnosis is often delayed or missed due to the non-specific nature of complaints and lack of disease awareness. Additionally, the disease-causing tumour is often difficult to detect and localize because they are often small, lack localizing symptoms and signs, and dwell in widely variable anatomical locations. Measuring serum/urine phosphate should be an inherent diagnostic component when assessing otherwise unexplained osteomalacia, fractures and weakness. In cases of hypophosphatemia with inappropriate (sustained) phosphaturia and inappropriately normal or frankly low 1,25-dihydroxy vitamin D, differentiation of the potential causes of renal phosphate wasting should include measurement of FGF23, and TIO should be considered. While patients experience severe disability without treatment, complete excision of the tumour is typically curative and results in a dramatic reversal of symptoms. Two additional key current unmet needs in optimizing TIO management are: (1 and 2) the considerable delay in diagnosis and consequent delay between the onset of symptoms and surgical resection; and (2) alternative management. These may be addressed by raising awareness of TIO, and taking into consideration the accessibility and variability of different healthcare infrastructures. By recognizing the challenges associated with the diagnosis and treatment of TIO and by applying a stepwise approach with clear clinical practice guidelines, patient care and outcomes will be improved in the future.
Topics: Fibroblast Growth Factor-23; Fibroblast Growth Factors; Humans; Hypophosphatemia; Neoplasms, Connective Tissue; Osteomalacia; Paraneoplastic Syndromes
PubMed: 34147708
DOI: 10.1016/j.bone.2021.116064 -
Current Opinion in Rheumatology May 1994Tumor-induced or oncogenous osteomalacia is a rare paraneoplastic syndrome characterized by osteomalacia with hypophosphatemia, hyperphosphaturia, and undetectable or... (Review)
Review
Tumor-induced or oncogenous osteomalacia is a rare paraneoplastic syndrome characterized by osteomalacia with hypophosphatemia, hyperphosphaturia, and undetectable or inappropriately low circulating concentrations of 1,25-dihydroxyvitamin D3. The syndrome is associated with the presence of a tumor whose successful removal leads to clinical and biochemical cure. More than 80 cases of tumor-induced osteomalacia have been reported, but recognition of affected persons is still frequently delayed or neglected. This has been due, in part, to difficulty in locating the tumors that cause the disorder, but it may also be the result of inappropriate assessment of the cause of hypophosphatemia. Progress in identifying the pathophysiology of tumor-related osteomalacia has therefore been limited. However, there may be homologies between tumor-related osteomalacia and inherited hypophosphatemia. Studies of the latter, which are included in this review, may help to elucidate the factor or factors that cause tumor-induced osteomalacia.
Topics: Adult; Aged; Animals; Child; Humans; Hypophosphatemia, Familial; Osteomalacia; Paraneoplastic Syndromes
PubMed: 8060772
DOI: 10.1097/00002281-199405000-00017 -
Advances in Experimental Medicine and... 1980
Review
Topics: Bone and Bones; Cartilage; Humans; Minerals; Osteomalacia
PubMed: 6999862
DOI: 10.1007/978-1-4615-9167-2_59 -
Clinical Rheumatology Jan 1996The case of a 49-year-old woman suffering from generalized skeletal pain and multiple fractures accompanied by severe hypophosphataemia and low urinary phosphorus... (Review)
Review
The case of a 49-year-old woman suffering from generalized skeletal pain and multiple fractures accompanied by severe hypophosphataemia and low urinary phosphorus excretion is reported. She had been taking large amounts of antacids containing aluminum hydroxide for many years. A diagnosis of antacid-induced osteomalacia was made. It was confirmed by biological work-up, radiographs and bone biopsy. A dramatic biological, osteodensitometric, and clinical improvement was achieved by withdrawal of antacids and phosphorus administration. The literature concerning this unusual condition has been reviewed.
Topics: Adult; Aged; Antacids; Biopsy, Needle; Bone Density; Female; Heartburn; Humans; Hypophosphatemia; Male; Middle Aged; Osteomalacia; Phosphorus; Tomography, X-Ray Computed
PubMed: 8929782
DOI: 10.1007/BF02231691 -
Zeitschrift Fur Rheumatologie Apr 2022Tumor-induced osteomalacia (TIO) or oncogenic osteomalacia (OOM) is a rare paraneoplastic renal phosphate wasting syndrome. The disease is mostly triggered by small,... (Review)
Review
Tumor-induced osteomalacia (TIO) or oncogenic osteomalacia (OOM) is a rare paraneoplastic renal phosphate wasting syndrome. The disease is mostly triggered by small, benign mesenchymal tumors that express somatostatin receptors (SSTR) and produce excessive levels of fibroblast growth factor 23 (FGF 23) or other phosphatonins. These reduce the phosphate back resorption in the proximal tubules of the kidneys, thereby causing hypophosphatemia and lead to an absolute or relatively low calcitriol serum concentration. The main symptoms include muscle weakness, bone pain and recurrent insufficiency fractures secondary to sometimes pronounced osteomalacia. The suspected diagnosis can only be confirmed by determination of the phosphate level. It can often take years before the tumor is successfully localized. The necessary tumor localization is often the most difficult step in the treatment before the OOM can be curatively treated by open surgical resection of the tumor. In recent years new approaches for faster tumor localization and treatment of the tumor have been developed. Positron emission tomography (PET) in co-registration with computed tomography (Ga-DOTA-TATE PET/CT) is currently the most sensitive imaging methodology for tumor detection. The application of the monoclonal FGF 23 antibody burosumab represents a promising new option in the treatment of inoperable adult OOM.
Topics: Adult; Fibroblast Growth Factors; Humans; Neoplasms; Osteomalacia; Paraneoplastic Syndromes; Positron Emission Tomography Computed Tomography
PubMed: 35103802
DOI: 10.1007/s00393-022-01160-1 -
Der Internist Feb 1991
Review
Topics: Bone and Bones; Female; Humans; Male; Middle Aged; Osteomalacia; Phosphates; Risk Factors; Vitamin D; Vitamin D Deficiency
PubMed: 2032793
DOI: No ID Found -
Skeletal Radiology Mar 2000
Review
Topics: Animals; Humans; Osteomalacia; Paraneoplastic Syndromes; Radiography
PubMed: 10794548
DOI: 10.1007/s002560050581 -
JPMA. the Journal of the Pakistan... Oct 1979
Topics: Humans; Osteomalacia; Vitamin D Deficiency
PubMed: 117133
DOI: No ID Found