PMID- 27085966 OWN - NLM STAT- MEDLINE DCOM- 20180409 LR - 20221207 IS - 1435-5604 (Electronic) IS - 0914-8779 (Linking) VI - 35 IP - 3 DP - 2017 May TI - Reports of 17 Chinese patients with tumor-induced osteomalacia. PG - 298-307 LID - 10.1007/s00774-016-0756-9 [doi] AB - Tumor-induced osteomalacia (TIO) is a rare acquired form of hypophosphatemic osteomalacia, which is usually attributed to the overproduction of fibroblast growth factor 23 (FGF-23) by benign mesenchymal neoplasms. Localization and thereafter surgical resection of tumors lead to a cure. The present study aimed to investigate the clinical data, diagnostic methods, and follow-up after tumor resection at one medical center in Shanghai to characterize the profile of this rare disorder and to share our successful experience in diagnosis and treatment. Twenty-three patients with adult-onset hypophosphatemia osteomalacia seen in Shanghai Sixth People's Hospital from 2009 to 2014 and 95 normal individuals were enrolled. After taking a medical history and performing a physical examination, we analyzed the laboratory results (including the serum FGF-23 levels) and localized the tumors by (18)F-fluorodeoxyglucose positron emission tomography and computed tomography ((18)F-FDG PET/CT), (99m)Tc-octreotide ((99m)Tc-OCT) scintigraphy, and magnetic resonance imaging (MRI). On the basis of the results of laboratory tests and imaging findings, tumor resection was conducted in 17 patients with a certain diagnosis of TIO. The results demonstrated that the 17 patients (nine men and eight women, average age 46.6 +/- 12.9 years) had TIO. FGF-23 level was elevated in 94.1 % of patients (16 of 17 patients) . Serum phosphorus level decreased in 100 % of patients. (18)F-FDG PET/CT revealed five tumors, (99m)Tc-OCT scintigraphy revealed two tumors, physical examination revealed nine tumors, and MRI revealed one tumor, among which 58.8 % of the causative tumors (10 of 17 tumors) were located in the lower extremities. After tumor resection, serum phosphorus levels normalized in 100 % of patients (all 17 patients) in 4-21 days and FGF-23 levels decreased in 90 % of patients (nine of ten patients). We found 64.7 % of the tumors (11 of 17 tumors) were phosphaturic mesenchymal tumors or a phosphaturic mesenchymal tumor mixed connective tissue variant. Measurement of serum phosphorus and FGF-23 levels in patients with suspected TIO is of paramount importance for diagnosing of TIO. (18)F-FDG PET/CT, (99m)Tc-OCT scintigraphy, and physical examination play a considerable role in revealing TIO-associated tumors. TIO-associated tumors were more frequently located in the lower extremities than in other places; thus, the lower extremities need to be carefully checked. Complete surgical resection results in normalization of parameters in laboratory tests and relief of symptoms of TIO patients. FAU - Yu, Wei-Jia AU - Yu WJ AD - Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi-Shan Rd, Shanghai, 200233, People's Republic of China. FAU - He, Jin-Wei AU - He JW AD - Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi-Shan Rd, Shanghai, 200233, People's Republic of China. FAU - Fu, Wen-Zhen AU - Fu WZ AD - Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi-Shan Rd, Shanghai, 200233, People's Republic of China. FAU - Wang, Chun AU - Wang C AD - Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi-Shan Rd, Shanghai, 200233, People's Republic of China. chunwang66@gmail.com. FAU - Zhang, Zhen-Lin AU - Zhang ZL AD - Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yi-Shan Rd, Shanghai, 200233, People's Republic of China. zzl2002@medmail.com.cn. LA - eng PT - Journal Article DEP - 20160416 PL - Japan TA - J Bone Miner Metab JT - Journal of bone and mineral metabolism JID - 9436705 RN - 0 (99mTc-octreotide) RN - 0 (FGF23 protein, human) RN - 0 (Organotechnetium Compounds) RN - 27YLU75U4W (Phosphorus) RN - 62031-54-3 (Fibroblast Growth Factors) RN - 7Q7P4S7RRE (Fibroblast Growth Factor-23) RN - EC 3.1.3.1 (Alkaline Phosphatase) RN - RWM8CCW8GP (Octreotide) RN - Oncogenic osteomalacia SB - IM MH - Adult MH - Aged MH - Alkaline Phosphatase/blood MH - Asian People/*genetics MH - China MH - Female MH - Fibroblast Growth Factor-23 MH - Fibroblast Growth Factors/blood MH - Follow-Up Studies MH - Humans MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Neoplasms, Connective Tissue/blood/diagnostic imaging/*pathology/surgery MH - Octreotide/analogs & derivatives/chemistry MH - Organotechnetium Compounds/chemistry MH - Osteomalacia MH - Paraneoplastic Syndromes MH - Phosphorus/blood MH - Positron Emission Tomography Computed Tomography MH - Young Adult OTO - NOTNLM OT - 18F-Fluorodeoxyglucose positron emission tomography and computed tomography OT - Fibroblast growth factor 23 OT - Tumor-induced osteomalacia EDAT- 2016/04/18 06:00 MHDA- 2018/04/10 06:00 CRDT- 2016/04/18 06:00 PHST- 2015/07/19 00:00 [received] PHST- 2016/03/06 00:00 [accepted] PHST- 2016/04/18 06:00 [pubmed] PHST- 2018/04/10 06:00 [medline] PHST- 2016/04/18 06:00 [entrez] AID - 10.1007/s00774-016-0756-9 [pii] AID - 10.1007/s00774-016-0756-9 [doi] PST - ppublish SO - J Bone Miner Metab. 2017 May;35(3):298-307. doi: 10.1007/s00774-016-0756-9. Epub 2016 Apr 16.