{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:00:57Z","timestamp":1791489657110,"version":"4.3.4"},"reference-count":24,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,6,1]]},"abstract":"<jats:p>Tumor-induced osteomalacia\/rickets is a rare paraneoplastic disorder associated with a tumor-producing fibroblast growth factor 23 (FGF23). We present a child with symptoms of rickets as the first clinical sign of a central giant cell granuloma (CGCG) with high serum levels of FGF23, a hormone associated with decreased phosphate resorption. A 3-year-old boy presented with a limp and 6 months later with painless growth of the jaw. On examination gingival hypertrophy and genu varum were observed. Investigations revealed hypophosphatemia, normal 1,25 and 25 (OH) vitamin D, and high alkaline phosphatase. An MRI showed an osteolytic lesion of the maxilla. Radiographs revealed typical rachitic findings. Incisional biopsy of the tumor revealed a CGCG with mesenchymal matrix. The CGCG was initially treated with calcitonin, but the lesions continued to grow, making it necessary to perform tracheostomy and gastrostomy. One year after onset the hyperphosphaturia worsened, necessitating increasing oral phosphate supplements up to 100 mg\/kg per day of elemental phosphorus. FGF23 levels were extremely high. Total removal of the tumor was impossible, and partial reduction was achieved after percutaneous computed tomography\u2013guided radiofrequency, local instillation of triamcinolone, and oral propranolol. Compassionate use of cinacalcet was unsuccessful in preventing phosphaturia. The tumor slowly regressed after the third year of disease; phosphaturia improved, allowing the tapering of phosphate supplements, and FGF23 levels normalized. Tumor-induced osteomalacia\/rickets is uncommon in children and is challenging for physicians to diagnose. It should be suspected in patients with intractable osteomalacia or rickets. A tumor should be ruled out if FGF23 levels are high.<\/jats:p>","DOI":"10.1542\/peds.2014-2218","type":"journal-article","created":{"date-parts":[[2015,5,26]],"date-time":"2015-05-26T00:31:08Z","timestamp":1432600268000},"page":"e1518-e1523","source":"Crossref","is-referenced-by-count":27,"title":["Tumor-Induced Rickets in a Child With a Central Giant Cell Granuloma: A Case Report"],"prefix":"10.1542","volume":"135","author":[{"given":"Elisa","family":"Fern\u00e1ndez-Cooke","sequence":"first","affiliation":[{"name":"Departments of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Cruz-Rojo","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Gallego","sequence":"additional","affiliation":[{"name":"Radiology, Division of Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Isabel","family":"Romance","sequence":"additional","affiliation":[{"name":"Oral & Maxillofacial Surgery, Division of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocio","family":"Mosqueda-Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda","family":"Almaden","sequence":"additional","affiliation":[{"name":"Lipid and Atherosclerosis Unit, IMIBIC\/Reina Sofia University Hospital\/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"S\u00e1nchez del Pozo","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2015,6,1]]},"reference":[{"issue":"1","key":"2021121100503886700_B1","first-page":"33","article-title":"Osteomalacia with Looser\u2019s nodes (Milkman\u2019s syndrome) due to a raised resistance to vitamin D acquired about the age of 15 years.","volume":"16","author":"McCance","year":"1947","journal-title":"Q J Med"},{"issue":"1","key":"2021121100503886700_B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00000478-200401000-00001","article-title":"Most osteomalacia-associated mesenchymal tumors are a single histopathologic entity: an analysis of 32 cases and a comprehensive review of the literature.","volume":"28","author":"Folpe","year":"2004","journal-title":"Am J Surg Pathol"},{"issue":"6","key":"2021121100503886700_B3","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1681\/ASN.2007010068","article-title":"How fibroblast growth factor 23 works.","volume":"18","author":"Liu","year":"2007","journal-title":"J Am Soc Nephrol"},{"issue":"9","key":"2021121100503886700_B4","doi-asserted-by":"crossref","first-page":"4088","DOI":"10.1210\/jc.2002-021919","article-title":"Clinical case seminar: fibroblast growth factor 23: a new clinical marker for oncogenic osteomalacia.","volume":"88","author":"Nelson","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"issue":"11","key":"2021121100503886700_B5","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1359\/JBMR.050718","article-title":"Fibroblast growth factor-23 is regulated by 1alpha, 25-dihydroxyvitamin D","volume":"20","author":"Collins","year":"2005","journal-title":"J Bone Miner Res."},{"issue":"1","key":"2021121100503886700_B6","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s100240050008","article-title":"Phosphaturic mesenchymal tumor-induced rickets.","volume":"3","author":"Reyes-M\u00fagica","year":"2000","journal-title":"Pediatr Dev Pathol"},{"key":"2021121100503886700_B7","article-title":"Tumor-induced osteomalacia caused by phosphaturic mesenchymal tumor of the cervical spine","author":"Nakamura","year":"2014","journal-title":"J Orthop Sci"},{"key":"2021121100503886700_B8","doi-asserted-by":"crossref","unstructured":"Houang M, Clarkson A, Sioson L, et al. 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Accessed June 19, 2014","DOI":"10.1001\/jamaoto.2013.6723"},{"issue":"6","key":"2021121100503886700_B21","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1359\/jbmr.070304","article-title":"Cinacalcet in the management of tumor-induced osteomalacia","volume":"22","author":"Geller","year":"2007","journal-title":"J Bone Miner Res."},{"issue":"12","key":"2021121100503886700_B22","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1007\/s00467-003-1290-2","article-title":"Calcimimetic agents and secondary hyperparathyroidism: rationale for use and results from clinical trials.","volume":"18","author":"Goodman","year":"2003","journal-title":"Pediatr Nephrol"},{"issue":"10","key":"2021121100503886700_B23","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1007\/s00467-007-0742-5","article-title":"Cinacalcet is efficacious in pediatric dialysis patients.","volume":"23","author":"Silverstein","year":"2008","journal-title":"Pediatr Nephrol"},{"key":"2021121100503886700_B24","doi-asserted-by":"crossref","unstructured":"Fukumoto S. 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