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Similar Publications

18F-Sodium Fluoride PET/CT as a Tool to Assess Enthesopathies in X-Linked Hypophosphatemia.

Calcif Tissue Int

January 2025

Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Av. Diagonal Paraguay 262, Cuarto Piso, Santiago, Chile.

X-linked hypophosphatemia (XLH) is a rare metabolic disorder characterized by elevated FGF23 and chronic hypophosphatemia, leading to impaired skeletal mineralization and enthesopathies that are associated with pain, stiffness, and diminished quality of life. The natural history of enthesopathies in XLH remains poorly defined, partly due to absence of a sensitive quantitative tool for assessment and monitoring. This study investigates the utility of 18F-NaF PET/CT scans in characterizing enthesopathies in XLH subjects.

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Article Synopsis
  • Iron deficiency anemia is typically treated with iron infusions, but evidence suggests these can lead to low phosphate levels and osteomalacia due to high levels of iFGF23.
  • A study on 13 patients receiving ferric carboxymaltose infusions showed that stopping these infusions along with phosphate and vitamin D supplementation normalized phosphate levels, reduced pain, and improved bone density.
  • One patient continued to receive iron infusions but benefitted from burosumab treatment, underscoring the need to monitor phosphate levels in patients undergoing such therapies.
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Intravenous iron supplementation is increasingly used to safely and effectively correct iron deficiency anemia, but some formulations are linked to a renal phosphate wasting syndrome which is mediated by fibroblast growth factor 23. Unawareness among prescribers and the nonspecific clinical symptoms of hypophosphatemia result in underreporting of this complication. Even though it is often an asymptomatic and self-limiting condition, accumulating evidence from case reports and dedicated randomized controlled trials show that IV iron induced hypophosphatemia may be associated with clinical symptoms.

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Objective: This study aims to report the application of 18F-AlF-NOTA-Octreotide PET/CT and 3D printing technology in the diagnosis and treatment of phosphaturic mesenchymal tumors (PMT) in patients with tumor-induced osteomalacia (TIO).

Case Presentation: A 68-year-old male patient (Case 1) was admitted to the Weifang People's Hospital in August 2022 with complaints of "persistent pain in the bilateral flank and lumbosacral region". 18F-AlF-NOTA-Octreotide PET/CT showed high octreotide expression in the left femoral region.

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