The pathophysiology of hypophosphatemia
BEST PRACTICE & RESEARCH CLINICAL ENDOCRINOLOGY & METABOLISM(2024)
Abstract
After identification of fibroblast growth factor (FGF) 23 as the pivotal regulator of chronic serum inorganic phosphate (Pi) levels, the etiology of disorders causing hypophosphatemic rickets/osteomalacia has been clarified, and measurement of intact FGF23 serves as a potent tool for differential diagnosis of chronic hypophosphatemia. Additionally, measurement of bone -specific alkaline phosphatase (BAP) is recommended to differentiate acute and subacute hypophosphatemia from chronic hypophosphatemia. This article divides the etiology of chronic hypophosphatemia into 4 groups: A. FGF23 related, B. primary tubular dysfunction, C. disturbance of vitamin D metabolism, and D. parathyroid hormone 1 receptor (PTH1R) mediated. Each group is further divided into its inherited form and acquired form. Topics for each group are described, including "ectopic FGF23 syndrome," "alcohol consumption -induced FGF23-related hypophosphatemia," "anti-mitochondrial antibody associated hypophosphatemia," and "vitamin D -dependent rickets type 3." Finally, a flowchart for differential diagnosis of chronic hypophosphatemia is introduced. (c) 2023 Elsevier Ltd. All rights reserved.
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Key words
hypophosphatemia,vitamin D,fibroblast growth factor 23,fibroblast growth factor receptor 1,parathyroid hormone,parathyroid hormone -related protein,rickets,osteomalacia
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