{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:35:56Z","timestamp":1793039756544,"version":"4.5.0"},"reference-count":25,"publisher":"Walter de Gruyter GmbH","issue":"3","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objective.<\/jats:bold>\n                    Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by chronic hypophosphatemia and osteomalacia. We present case of a patient with a protracted clinical course of TIO. TIO profoundly affected every aspect of his life with subsequent profound physical and psychosocial disabilities.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Method.<\/jats:bold>\n                    The review of a complex clinical presentation, serial laboratory investigations, and imaging modalities of a patient with TIO caused by a mesenchymal tumor.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results.<\/jats:bold>\n                    The patient presented with chronic lower back pain, severe bilateral leg weakness, and multiple pathological fractures due to severe osteoporosis. His investigations revealed hypophosphatemia, low 1,25 dihydroxyvitamin D, phosphaturia and normal serum calcium, and parathyroid hormone. Elevated fibroblast growth factor 23 (FGF23) confirmed the diagnosis of TIO and\n                    <jats:sup>68<\/jats:sup>\n                    Ga-DOTATATE-positron emission tomography\/computed tomography (PET\/CT) imaging correctly identified a tumor in the left femoral head. His clinical features and biochemical abnormalities promptly recovered after successful surgical resection of the mesenchymal tumor.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion.<\/jats:bold>\n                    The present case demonstrated the need to extensively investigate causes of generalized bone pain in patients with hypophosphatemia, as TIO is highly curable. Importantly,\n                    <jats:sup>68<\/jats:sup>\n                    Ga-DOTATATE PET\/CT imaging successfully identified the FGF23 producing tumor, which was undetectable by conventional imaging, favoring its early use in suspected TIO presentation. The present report highlights the importance of timely diagnosis of this complex medical condition, aiming to improve general awareness and enable better clinical outcomes for this rare disorder.\n                  <\/jats:p>","DOI":"10.2478\/enr-2021-0017","type":"journal-article","created":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T03:30:00Z","timestamp":1631676600000},"page":"163-168","source":"Crossref","is-referenced-by-count":3,"title":["Tumor-induced osteomalacia \u2013 a mystery illness beyond aches, pains, and depression"],"prefix":"10.2478","volume":"55","author":[{"given":"Huajing (Jing)","family":"Ni","sequence":"first","affiliation":[{"name":"Endocrinology Department , Sutherland Hospital , Sydney , NSW , Australia"},{"name":"Faculty of Medicine , University of New South Wales , NSW , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roderick","family":"Clifton-Bligh","sequence":"additional","affiliation":[{"name":"Endocrinology Department , Royal North Shore Hospital , Sydney , NSW , Australia"},{"name":"Faculty of Medicine , University of Sydney , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malgorzata Monika","family":"Brzozowska","sequence":"additional","affiliation":[{"name":"Endocrinology Department , Sutherland Hospital , Sydney , NSW , Australia"},{"name":"Faculty of Medicine , University of New South Wales , NSW , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2021,9,13]]},"reference":[{"key":"2026042722155364124_j_enr-2021-0017_ref_001","doi-asserted-by":"crossref","unstructured":"ADHR Consortium. Autosomal dominant hypophosphataemic rickets is associated with mutations in FGF23. Nat Genet 26, 345\u2013348, 2000.10.1038\/8166411062477","DOI":"10.1038\/81664"},{"key":"2026042722155364124_j_enr-2021-0017_ref_002","unstructured":"Campion J, Maricic M. Osteoporosis in men. Am Fam Physician 67, 1521\u20131526, 2003."},{"key":"2026042722155364124_j_enr-2021-0017_ref_003","doi-asserted-by":"crossref","unstructured":"Carpenter T. Oncogenic osteomalacia--a complex dance of factors. N Engl J Med 348, 1705\u20131708, 2003.10.1056\/NEJMe03003712711747","DOI":"10.1056\/NEJMe030037"},{"key":"2026042722155364124_j_enr-2021-0017_ref_004","doi-asserted-by":"crossref","unstructured":"Chong W, Molinolo A, Chen C, Collins M. Tumor-induced osteomalacia. Endocr Relat Cancer 18, R53\u201377, 2011.10.1530\/ERC-11-0006343374121490240","DOI":"10.1530\/ERC-11-0006"},{"key":"2026042722155364124_j_enr-2021-0017_ref_005","doi-asserted-by":"crossref","unstructured":"Clifton-Bligh R, Hofman M, Duncan E, Sim Ie, Darnell D, Clarkson A, Wong T, Walsh J, Gill A, Ebeling P, Hicks R. Improving diagnosis of tumor-induced osteomalacia with Gallium-68 DOTATATE PET\/CT. J Clin Endocrinol Metab 98, 687\u2013694, 2013.10.1210\/jc.2012-364223295468","DOI":"10.1210\/jc.2012-3642"},{"key":"2026042722155364124_j_enr-2021-0017_ref_006","doi-asserted-by":"crossref","unstructured":"Colt E, Gopan T, Chong H. Oncogenic osteomalacia cured by removal of an organized hematoma. Endocrine Practice 11, 190\u2013193, 2005.10.4158\/EP.11.3.19016239206","DOI":"10.4158\/EP.11.3.190"},{"key":"2026042722155364124_j_enr-2021-0017_ref_007","doi-asserted-by":"crossref","unstructured":"Econs M, Drezner M. Tumor-induced osteomalacia--unveiling a new hormone. N Engl J Med 330, 1679\u20131681, 1994.10.1056\/NEJM1994060933023108177274","DOI":"10.1056\/NEJM199406093302310"},{"key":"2026042722155364124_j_enr-2021-0017_ref_008","doi-asserted-by":"crossref","unstructured":"Edmister K, Sundaram M. Oncogenic osteomalacia. Semin Musculoskelet Radiol 6, 191\u2013196, 2002.10.1055\/s-2002-3671612541196","DOI":"10.1055\/s-2002-36716"},{"key":"2026042722155364124_j_enr-2021-0017_ref_009","doi-asserted-by":"crossref","unstructured":"El-Maouche D, Sadowski S, Papadakis G, Guthrie L, Cottle-Delisle C, Merkel R, Millo C, Chen C, Kebebew E, Collins MT. (68)Ga-DOTATATE for tumor localization in tumor-induced osteomalacia. J Clin Endocrinol Metab 101, 3575\u20133581, 2016.10.1210\/jc.2016-2052505234427533306","DOI":"10.1210\/jc.2016-2052"},{"key":"2026042722155364124_j_enr-2021-0017_ref_010","doi-asserted-by":"crossref","unstructured":"Hautmann A, Hautmann M, Kolbl O, Herr W, Fleck M. Tumor-induced osteomalacia: an up-to-date review. Curr Rheumatol Rep 17, 512, 2015.10.1007\/s11926-015-0512-525900190","DOI":"10.1007\/s11926-015-0512-5"},{"key":"2026042722155364124_j_enr-2021-0017_ref_011","doi-asserted-by":"crossref","unstructured":"Hu F, Jiang C, Zhang Q, Shi H, Wei L, Wang Y. Quantitative ELISA-like immunohistochemistry of fibroblast growth factor 23 in diagnosis of tumor-induced osteomalacia and clinical characteristics of the disease. Dis Markers 2016, 3176978, 2016.10.1155\/2016\/3176978480852827034530","DOI":"10.1155\/2016\/3176978"},{"key":"2026042722155364124_j_enr-2021-0017_ref_012","doi-asserted-by":"crossref","unstructured":"Jagtap V, Sarathi V, Lila A, Malhotra G, Sankhe S, Bandgar T, Menon P, Shah N. Tumor-induced osteomalacia: a single center experience. Endocrine Practice 17, 177\u2013184, 2011.10.4158\/EP10151.OR","DOI":"10.4158\/EP10151.OR"},{"key":"2026042722155364124_j_enr-2021-0017_ref_013","doi-asserted-by":"crossref","unstructured":"Jan de Beur SM. Tumor-induced osteomalacia. JAMA 294, 1260\u20131267, 2005.10.1001\/jama.294.10.1260","DOI":"10.1001\/jama.294.10.1260"},{"key":"2026042722155364124_j_enr-2021-0017_ref_014","doi-asserted-by":"crossref","unstructured":"Jonsson K, Zahradnik R, Larsson T, White K, Sugimoto T, Imanishi Y, Jamamoto T, Hampson G, Koshiyama H, Ljunggren O, Oba K, Yang M, Miyauchi A, Econs M, Lavinge J, Juppner H. Fibroblast growth factor 23 in oncogenic osteomalacia and X-linked hypophosphatemia. N Engl J Med 348, 1656\u20131663, 2003.10.1056\/NEJMoa020881","DOI":"10.1056\/NEJMoa020881"},{"key":"2026042722155364124_j_enr-2021-0017_ref_015","doi-asserted-by":"crossref","unstructured":"Liu S, Zhou X, Song A, Huo Z, Wang Y, Xia W, Liu Y. Successful treatment of tumor-induced osteomalacia causing by phosphaturic mesenchymal tumor of the foot. Medicine (Baltimore) 98, e16296, 2019.10.1097\/MD.0000000000016296","DOI":"10.1097\/MD.0000000000016296"},{"key":"2026042722155364124_j_enr-2021-0017_ref_016","doi-asserted-by":"crossref","unstructured":"Perwad F, Zhang M, Tenenhouse H, Portale A. Fibroblast growth factor 23 impairs phosphorus and vitamin D metabolism in vivo and suppresses 25-hydroxyvitamin D-1alpha-hydroxylase expression in vitro. Am J Physiol Renal Physiol 293, F1577\u2013F1583, 2007.10.1152\/ajprenal.00463.2006","DOI":"10.1152\/ajprenal.00463.2006"},{"key":"2026042722155364124_j_enr-2021-0017_ref_017","doi-asserted-by":"crossref","unstructured":"Ryan E, Reiss E. Oncogenous osteomalacia. Review of the world literature of 42 cases and report of two new cases. Am J Med 77, 501\u2013512, 1984.10.1016\/0002-9343(84)90112-8","DOI":"10.1016\/0002-9343(84)90112-8"},{"key":"2026042722155364124_j_enr-2021-0017_ref_018","doi-asserted-by":"crossref","unstructured":"Seemann L, Padala S, Mohammed A, Belayneh N. Tumor-induced osteomalacia and the importance of plasma fibro-blast growth factor 23 as an indicator: diagnostic delay leads to a suicide attempt. J Investig Med High Impact Case Rep 7, 2324709619895162, 2019.10.1177\/2324709619895162692352631850815","DOI":"10.1177\/2324709619895162"},{"key":"2026042722155364124_j_enr-2021-0017_ref_019","doi-asserted-by":"crossref","unstructured":"Siegel H, Rock M, Inwards C, Sim F. Phosphaturic mesenchymal tumor. Orthopedics 25, 1279\u20131281, 2002.10.3928\/0147-7447-20021101-2112452347","DOI":"10.3928\/0147-7447-20021101-21"},{"key":"2026042722155364124_j_enr-2021-0017_ref_020","doi-asserted-by":"crossref","unstructured":"Slot-Steenks M, Hamdy N, van de Sande M, Vriens D, Cleven A, Appelman-Dijkstra N. Identifying the culprit lesion in tumor induced hypophosphatemia, the solution of a clinical enigma. Endocrine 54, 642\u2013647, 2016.10.1007\/s12020-016-1092-5510720127709474","DOI":"10.1007\/s12020-016-1092-5"},{"key":"2026042722155364124_j_enr-2021-0017_ref_021","doi-asserted-by":"crossref","unstructured":"The HYP Consortium. A gene (PEX) with homologies to endopeptidases is mutated in patients with X-linked hypophosphatemic rickets. Nat Genet 11, 130\u2013136, 1995.10.1038\/ng1095-1307550339","DOI":"10.1038\/ng1095-130"},{"key":"2026042722155364124_j_enr-2021-0017_ref_022","doi-asserted-by":"crossref","unstructured":"Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30, 473\u2013483, 1992.10.1097\/00005650-199206000-00002","DOI":"10.1097\/00005650-199206000-00002"},{"key":"2026042722155364124_j_enr-2021-0017_ref_023","doi-asserted-by":"crossref","unstructured":"Wu W, Wang C, Ruan J, Chen F, Li N, Chen F. A case report of phosphaturic mesenchymal tumor-induced osteomalacia. Medicine (Baltimore) 96, e9470. 2017.10.1097\/MD.0000000000009470575828829390586","DOI":"10.1097\/MD.0000000000009470"},{"key":"2026042722155364124_j_enr-2021-0017_ref_024","doi-asserted-by":"crossref","unstructured":"Yamazaki Y, Okazaki R, Shibata M, Hasegawa Y, Satoh K, Tajima T, Takeuchi Y, Fujita T, Nakahara K, Yamashita T, Fukumoto S. Increased circulatory level of biologically active full-length FGF-23 in patients with hypophosphatemic rickets\/osteomalacia. J Clin Endocrinol Metab 87, 4957\u20134960, 2002.10.1210\/jc.2002-02110512414858","DOI":"10.1210\/jc.2002-021105"},{"key":"2026042722155364124_j_enr-2021-0017_ref_025","doi-asserted-by":"crossref","unstructured":"Yu W, He J, Fu W, Wang C, Zhang Z. Reports of 17 Chinese patients with tumor-induced osteomalacia. J Bone Miner Metab 35, 298\u2013307, 2017.10.1007\/s00774-016-0756-927085966","DOI":"10.1007\/s00774-016-0756-9"}],"container-title":["Endocrine Regulations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/reference-global.com\/pdf\/10.2478\/enr-2021-0017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T03:57:25Z","timestamp":1777348645000},"score":1,"resource":{"primary":{"URL":"https:\/\/reference-global.com\/article\/10.2478\/enr-2021-0017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,9,13]]},"published-print":{"date-parts":[[2021,7,1]]}},"alternative-id":["10.2478\/enr-2021-0017"],"URL":"https:\/\/doi.org\/10.2478\/enr-2021-0017","relation":{},"ISSN":["1336-0329"],"issn-type":[{"value":"1336-0329","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,1]]}}}