000			nab a22 7a 4500
999			_c17459 _d17459
003			PC17459
005			20230518125321.0
008			230518b xxu||||| |||| 00| 0 eng d
040			_cH12O
041			_aeng
100			_91173 _aFernández Cooke, Elisa _ePediatría
100			_9794 _aCruz Rojo, Jaime _ePediatría
100			_92970 _aGallego Herrero, María Carmen _eRadiología Pediátrica
100			_9843 _aRomance García, Ana Isabel _eCirugía Maxilofacial
100			_9792 _aMosqueda Peña, Rocío _eNeonatología
100			_91156 _aSánchez del Pozo, Jaime _eEndocrinología Pediátrica
245	0	0	_aTumor-induced rickets in a child with a central giant cell granuloma: a case report. _h[caso clínico]
260			_bPediatrics, _c2015
300			_a135(6):e1518-23.
500			_aFormato Vancouver: Fernández Cooke E, Cruz Rojo J, Gallego C, Romance AI, Mosqueda Peña R, Almaden Y et al. Tumor-induced rickets in a child with a central giant cell granuloma: a case report. Pediatrics. 2015 Jun;135(6):e1518-23.
501			_aPMID: 26009620
504			_aContiene 24 referencias
520			_aTumor-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-guided 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.
710			_9446 _aServicio de Pediatría-Neonatología
710			_9365 _aServicio de Cirugía Oral y Maxilofacial
710			_9793 _aServicio de Neonatología
856			_uhttp://pc-h12o-es.m-hdoct.a17.csinet.es/pdf/pc/1/pc17459.pdf _ySolicitar documento
942			_2ddc _cCAS _n0