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Her background included recurrent epistaxis, severe generalised bone pain and multiple insufficiency fractures and an undifferentiated autoimmune connective tissue disease. Chronic hypophosphataemia, elevated alkaline phosphatase and raised fibroblast growth factor 23 (FGF23) were also noted. An MRI head and subsequent <jats:sup>68<\/jats:sup>Ga CT\/positron emission tomography scan demonstrated an intensely avid tumour in the right ethmoid sinus, extending intracranially. Phosphate was aggressively replaced, and alfacalcidol was initiated to circumvent the effects of FGF23 on her kidneys and bone minerals. The tumour was biopsied and then definitively resected via combined endonasal and craniotomy approaches, resulting in good clinical improvement. FGF23 titre and serum phosphate both normalised leaving the diagnosis of a phosphaturic mesenchymal tumour-secreting FGF23, leading to tumour-induced osteomalacia.<\/jats:p>","DOI":"10.1136\/bcr-2023-259439","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:37:00Z","timestamp":1723163820000},"page":"e259439","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["FGF23-secreting sinonasal tumour presenting with acute subdural haemorrhage and tumour-induced osteomalacia"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7004-4568","authenticated-orcid":false,"given":"Sehajdev Singh","family":"Bhatia","sequence":"first","affiliation":[{"name":"Anaesthetics Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhjot Singh","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Poole","sequence":"additional","affiliation":[{"name":"Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anshuman","family":"Malaviya","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,8]]},"reference":[{"key":"2025082802312307000_17.8.e259439.1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.101545198"},{"key":"2025082802312307000_17.8.e259439.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-020-00691-6"},{"key":"2025082802312307000_17.8.e259439.3","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s12105-015-0668-3","article-title":"Phosphaturic mesenchymal tumor: 2 new oral cases and review of 53 cases in the head and neck","volume":"10","author":"Qari","year":"2016","journal-title":"Head Neck Pathol"},{"key":"2025082802312307000_17.8.e259439.4","doi-asserted-by":"publisher","DOI":"10.1006\/bbrc.2000.3696"},{"key":"2025082802312307000_17.8.e259439.5","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M207872200"},{"key":"2025082802312307000_17.8.e259439.6","doi-asserted-by":"publisher","DOI":"10.1530\/ERC-11-0006"},{"key":"2025082802312307000_17.8.e259439.7","first-page":"9","article-title":"Phosphatonins: physiological role and pathological changes","volume":"9","author":"Cavalli","year":"2012","journal-title":"Clin Cases Miner Bone Metab"},{"key":"2025082802312307000_17.8.e259439.8","doi-asserted-by":"crossref","DOI":"10.3390\/ijms24076661","article-title":"Mineral metabolism in children: interrelation between vitamin D and FGF23","volume":"24","author":"Pons-Belda","year":"2023","journal-title":"Int J Mol Sci"},{"key":"2025082802312307000_17.8.e259439.9","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.med.051308.111339"},{"key":"2025082802312307000_17.8.e259439.10","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1210\/endrev\/bnac026","article-title":"Tumor-induced osteomalacia: a comprehensive review","volume":"44","author":"Minisola","year":"2023","journal-title":"Endocr Rev"},{"key":"2025082802312307000_17.8.e259439.11","doi-asserted-by":"crossref","first-page":"162","DOI":"10.2500\/ar.2014.5.0100","article-title":"Sinonasal phosphaturic mesenchymal tumor: case report and systematic review","volume":"5","author":"Deep","year":"2014","journal-title":"Allergy Rhinol (Providence)"},{"key":"2025082802312307000_17.8.e259439.12","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2023.1116793","article-title":"Sphenoid sinus is a rare site for tumor-induced osteomalacia: a case report and literature review","volume":"14","author":"Wang","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2025082802312307000_17.8.e259439.13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12957-015-0763-7","article-title":"Tumour-induced osteomalacia: a literature review and a case report","volume":"14","author":"Dadoniene","year":"2015","journal-title":"World J Surg Onc"},{"key":"2025082802312307000_17.8.e259439.14","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1053\/j.semdp.2019.03.002","article-title":"Paraneoplastic syndromes and other systemic disorders associated with neuroendocrine neoplasms","volume":"36","author":"Guilmette","year":"2019","journal-title":"Semin Diagn Pathol"},{"key":"2025082802312307000_17.8.e259439.15","doi-asserted-by":"crossref","unstructured":"Filho MAS , da Silva NR , de Medeiros Fabrino VL , et al . 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