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Acquired Forms of Fibroblast Growth Factor 23-Related Hypophosphatemic Osteomalacia. Endocrinol Metab (Seoul) 2024; 39:255-261. [PMID: 38467164 PMCID: PMC11066443 DOI: 10.3803/enm.2023.1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Abstract
Fibroblast growth factor 23 (FGF23) is a pivotal humoral factor for the regulation of serum phosphate levels and was first identified in patients with autosomal dominant hypophosphatemic rickets and tumor-induced osteomalacia (TIO), the most common form of acquired FGF23-related hypophosphatemic rickets/osteomalacia (FGF23rHR). After the identification of FGF23, many other inherited and acquired forms of FGF23rHR were reported. In this review article, the detailed features of each acquired FGF23rHR are discussed, including TIO, ectopic FGF23 syndrome with malignancy, fibrous dysplasia/McCune-Albright syndrome, Schimmelpenning-Feuerstein-Mims syndrome/cutaneous skeletal hypophosphatemia syndrome, intravenous iron preparation-induced FGF23rHR, alcohol consumption-induced FGF23rHR, and post-kidney transplantation hypophosphatemia. Then, an approach for the differential diagnosis and therapeutic options for each disorder are concisely introduced. Currently, the majority of endocrinologists might only consider TIO when encountering patients with acquired FGF23rHR; an adequate differential diagnosis can reduce medical costs and invasive procedures such as positron emission tomography/computed tomography and venous sampling to identify FGF23-producing tumors. Furthermore, some acquired FGF23rHRs, such as intravenous iron preparation/alcohol consumption-induced FGF23rHR, require only cessation of drugs or alcohol to achieve full recovery from osteomalacia.
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Inherited Fanconi renotubular syndromes: unveiling the intricacies of hypophosphatemic rickets/osteomalacia. J Bone Miner Metab 2024; 42:155-165. [PMID: 38310177 DOI: 10.1007/s00774-023-01490-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/16/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Fanconi renotubular syndromes (FRTS) are a rare group of inherited phosphaturic disorders with limited Indian as well as global data on this condition. Here, we describe the experience of a single Endocrinology center from Western India on FRTS. MATERIALS AND METHODS Comprehensive clinical, biochemical, radiological, management, and genetic details of FRTS patients managed between 2010 and 2023 were collected and analyzed. RESULTS FRTS probands had mutations (eight novel) in six genes [CLCN5 (n = 4), SLC2A2 (n = 2), GATM, EHHADH, HNF4A, and OCRL (1 each)]. Among 15 FRTS patients (11 families), rickets/osteomalacia was the most common (n = 14) presentation with wide inter- and intra-familial phenotypic variability. Delayed diagnosis (median: 8.8 years), initial misdiagnosis (8/11 probands), and syndrome-specific discriminatory features (8/11 probands) were commonly seen. Hypophosphatemia, elevated alkaline phosphatase, normal parathyroid hormone (median: 36 pg/ml), high-normal/elevated 1,25(OH)2D (median: 152 pg/ml), hypercalciuria (median spot urinary calcium to creatinine ratio: 0.32), and variable proximal tubular dysfunction(s) were observed. Elevated C-terminal fibroblast growth factor 23 in two probands was misleading, till the genetic diagnosis was reached. Novel observations in our FRTS cohort were preserved renal function (till sixth decade) and enthesopathy in FRTS1 and FRTS3 families, respectively. CONCLUSION Our findings underscore frequent under- and misdiagnosis of FRTS; hence, a high index of suspicion for FRTS in phosphopenic rickets/osteomalacia, with early consideration of genetic testing is essential to ensure timely diagnosis of FRTS. The novel variants and phenotypic manifestations described here expand the disease spectrum of FRTS.
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Revisiting hypophosphatemic rickets/osteomalacia. Best Pract Res Clin Endocrinol Metab 2024; 38:101859. [PMID: 38238129 DOI: 10.1016/j.beem.2024.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
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Misdiagnosed metabolic bone abnormality: a case report. J Med Case Rep 2023; 17:436. [PMID: 37858137 PMCID: PMC10588102 DOI: 10.1186/s13256-023-04164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/05/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Metabolic bone disease causes significant morbidity and mortality, especially when misdiagnosed. With genetic testing, multiple disease pathologies can be analyzed. CASE PRESENTATION A 5-year and 9-month-old otherwise healthy Yemeni girl presented to her Yemen physician for evaluation of inward bending of her right knee and short stature. After extensive medical testing, she was given a diagnosis of hypophosphatemic rickets and growth hormone deficiency and started on treatment. Despite appropriate treatment, however, her condition continued to progress, prompting her family to pursue additional workup including genetic testing outside of Yemen. Genetic testing ultimately revealed a variation of unknown significance associated with amelogenesis imperfecta. CONCLUSIONS Hypophosphatemic rickets secondary to renal tubular acidosis was the working diagnosis. However, the patient's condition did not improve. Further genetic testing revealed a variation of unknown significance associated with amelogenesis imperfecta. We aim to present this case, provide an overview of the causes, and diagnostic metabolic bone health evaluation.
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Respiratory failure in a patient with hypophosphatemic rickets: can an endobronchial stent make the difference? Clin Med (Lond) 2023; 23:420-422. [PMID: 38614660 PMCID: PMC10541042 DOI: 10.7861/clinmed.2023-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Abnormalities associated with phosphate metabolism can lead to thoracic deformities that result in respiratory failure, which is conventionally managed by means of supplemental oxygenation, positive airway pressure and physiotherapy. However, when these measures fail, the clinician faces a dilemma, since many patients cannot tolerate a major surgical procedure. A minimally invasive technique, insertion of an endobronchial stent, might offer a solution.
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Bone Deformities and Kidney Failure: Coincidence of PHEX-Related Hypophosphatemic Rickets and m.3243A>G Mitochondrial Disease. Calcif Tissue Int 2022; 111:641-645. [PMID: 35916905 DOI: 10.1007/s00223-022-01010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022]
Abstract
X-linked hypophosphatemic rickets (XLH) and m.3243A>G mitochondrial disease share several clinical findings, including short stature, hearing impairment (HI), nephropathy, and hypertension. Here, we report on a case with the rare coincidence of these two genetic conditions. In early childhood, the patient presented with hypophosphatemia and bone deformities and was clinically diagnosed with XLH. This was genetically verified in adulthood with the identification of a de novo pathogenic deletion in phosphate-regulating endopeptidase homolog X-linked (PHEX). In addition, the patient developed HI and hypertension and when his mother was diagnosed with m.3243A>G, subsequent genetic testing confirmed the patient to carry the same variant. Over the next two decades, the patient developed progressive renal impairment however without nephrocalcinosis known to associate with XLH which could indicate an m.3243A>G-related kidney disease. Parallel with the progression of renal impairment, the patient developed hyperphosphatemia and secondary hyperparathyroidism. In conclusion, this case represents a complex clinical phenotype with the reversal of hypo- to hyperphosphatemia in XLH potentially mediated by the development of an m.3243A>G-associated nephropathy.
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A Case Report: First Long-Term Treatment With Burosumab in a Patient With Cutaneous-Skeletal Hypophosphatemia Syndrome. Front Endocrinol (Lausanne) 2022; 13:866831. [PMID: 35600592 PMCID: PMC9120998 DOI: 10.3389/fendo.2022.866831] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
Epidermal nevus syndromes encompass a highly heterogeneous group of systemic disorders, characterized by epidermal nevi, and a spectrum of neuromuscular, ocular, and bone abnormalities. Cutaneous-skeletal hypophosphatemia syndrome (CSHS) constitutes a specific sub-entity in which elevated levels of fibroblast growth factor-23 cause hypophosphatemic rickets that are, to date, not amenable to causal therapy. Here, we report the first long-term follow-up of causal treatment with burosumab in a 3-year-old female patient with CSHS. 4 weeks after initiation of burosumab treatment, serum phosphate normalized to age-appropriate levels. Furthermore, long-term follow-up of 42 months revealed significant improvement of linear growth and gross physical functions, including respiratory insufficiency. Radiographic rickets severity as well as subjective bone pain were strongly reduced, and no side effects were observed over the course of treatment. In summary, we, here, report about a successful treatment of hypophosphatemic rickets in CSHS with burosumab over the time course of 42 months. In our patient, burosumab showed convincing efficacy and safety profile, without any loss of effect or increase of dose.
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HYPOPHOSPHATEMIC RICKETS WITH RENAL HYPER-GLYCINURIA, RENAL GLUCOSURIA, AND GLYCYL-PROLINURIA. A SYNDROME WITH EVIDENCE FOR RENAL TUBULAR SECRETION OF PHOSPHORUS. Pediatrics 1964; 34:357-71. [PMID: 14211102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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BIOCHEMICAL BIOPSY EVALUATION OF THE EPIPHYSIAL MECHANISM IN A PATIENT WITH VITAMIN D-RESISTANT RICKETS. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 1964; 64:14-20. [PMID: 14192560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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[Primary hypophosphatemic vitamin-resistant rickets. Study of calcium metabolism with the aid of calcium 45]. ARCHIVES FRANCAISES DE PEDIATRIE 1963; 20:699-714. [PMID: 13964949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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Calcium-Phosphat-Stoffwechselver�nderungen bei Vitamin D-resistenter Rachitis. ACTA ACUST UNITED AC 1963; 41:416-9. [PMID: 13987421 DOI: 10.1007/bf01483303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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[Therapeutic problems in the treatment of genuine vitamin D-resistant rickets]. DIE MEDIZINISCHE WELT 1963; 11:572-9. [PMID: 13975473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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[VITAMIN D-RESISTANT RICKETS]. PEDIATRIA POLSKA 1963; 38:329-33. [PMID: 14049160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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[Vitamin-resistant hypophosphatemic rickets. Considerations on a case with insufficient ammoniogenesis]. ARCHIVES FRANCAISES DE PEDIATRIE 1963; 20:341-52. [PMID: 13991957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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Vitamin D-resistant rickets. Report of a case with discussion of radiographic findings. JOURNAL - NEWARK BETH ISRAEL HOSPITAL 1963; 14:68-77. [PMID: 13967222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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External calcium and phosphorus balances in vitamin D-resistant rickets. J Pediatr 1962; 61:288-90. [PMID: 13917205 DOI: 10.1016/s0022-3476(62)80273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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[Research on the pathogenesis of vitamin D-resistant rickets]. SCHWEIZERISCHE MEDIZINISCHE WOCHENSCHRIFT 1962; 92:895-7. [PMID: 13909768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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Studies on the pathogenesis of hypophosphatemic vitamin D refractory rickets of the simple type or phosphatdiabetes. ENDOCRINOLOGIA JAPONICA 1961; 8:272-8. [PMID: 14497332 DOI: 10.1507/endocrj1954.8.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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25
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[An unusual form of primary vitamin D-resistant rickets with hypocalcemia and autosomal-dominant hereditary transmission: hereditary pseudo-deficiency rickets]. HELVETICA PAEDIATRICA ACTA 1961; 16:452-68. [PMID: 14488440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Sporadic vitamin D resistant rickets: report of a case. N C Med J 1961; 22:506-8. [PMID: 13778551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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[Study on idiopathic hypophosphatemic vitamin-resistant rickets in children]. BULLETINS ET MEMOIRES DE LA SOCIETE MEDICALE DES HOPITAUX DE PARIS 1961; 77:373-87. [PMID: 13768121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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[Therapy with cocarboxylase of a case of vitamin D-resistant rickets]. ARCHIVIO DI ORTOPEDIA 1961; 74:621-8. [PMID: 13864878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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[Idiopathic hypophosphatemic vitamin-resistant rickets in children (Attempted dissociation of 2 different diseases by clinical, radiological, biological and genetic studies)]. ARCHIVES FRANCAISES DE PEDIATRIE 1961; 18:41-64. [PMID: 13744228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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[On the problem of vitamin D resistant rickets]. PEDIATRIIA 1960; 38:51-58. [PMID: 24545581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Aminoaciduria, glycosuria, and hypophosphatemic rickets (de Toni-Fanconi syndrome). UNITED STATES ARMED FORCES MEDICAL JOURNAL 1960; 11:916-22. [PMID: 13849014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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"Sporadic" hypophosphatemia and vitamin D-resistant rickets: report of a case. Pediatrics 1960; 25:959-66. [PMID: 13845343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Multiple genetic mechanisms in vitamin D-resistant rickets. Pediatrics 1960; 25:932-4. [PMID: 13845341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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34
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[Hereditary hypophosphatemic vitamin D-resistant rickets (phosphate diabetes)]. BIBLIOTHECA PAEDIATRICA 1960; 74:337-58. [PMID: 14434621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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35
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Genetic studies of vitamin D resistant rickets and familial hypophosphatemia. HELVETICA PAEDIATRICA ACTA 1959; 14:533-8. [PMID: 13845342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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[The effectiveness of dihydrotachysterol in vitamin D-resistant rickets and deficiency rickets]. HELVETICA PAEDIATRICA ACTA 1959; 14:472-82. [PMID: 13836149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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Familial hypophosphatemia with vitamin D-resistant rickets. II: three additional kindreds of the sex-linked dominant type with a genetic analysis of four such families. Am J Hum Genet 1959; 11:311-32. [PMID: 13828798 PMCID: PMC1932031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023] Open
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38
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[On the metabolism of phosphate by the kidneys in hypophosphatemic vitamin D-resistant rickets of the simple type and cystine storage disease. Reaction to prolonged calcium infusion]. HELVETICA PAEDIATRICA ACTA 1959; 14:497-505. [PMID: 13824624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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Familial vitamin D-resistant rickets. Metabolic studies in one family concerning aetiology and treatment, and indicating the separate actions of vitamin D. Arch Dis Child 1959; 34:383-91. [PMID: 13813931 PMCID: PMC2012412 DOI: 10.1136/adc.34.177.383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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40
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Genetic studies on vitamin D resistant rickets (familial hypophosphatemia). Am J Hum Genet 1959; 11:156-65. [PMID: 13661150 PMCID: PMC1931988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
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41
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[Vitamin D resistant rickets of phosphate-diabetic origin]. Orv Hetil 1959; 100:549-52. [PMID: 13645046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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42
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[Case reports & therapy of genuine vitamin D-resistant rickets]. ZEITSCHRIFT FUR KINDERHEILKUNDE 1959; 82:153-66. [PMID: 13660121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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[Genuine vitamin D-resistent rickets combined with feeblemindedness]. ZEITSCHRIFT FUR KINDERHEILKUNDE 1959; 83:187-94. [PMID: 14413867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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45
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Some observations on bone mineral in a case of vitamin D resistant rickets. HENRY FORD HOSPITAL MEDICAL BULLETIN 1958; 6:300-10. [PMID: 13610281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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[Results of the calcium perfusion test in idiopathic hypophosphatemic vitamin-resistant rickets]. REVUE FRANCAISE D'ETUDES CLINIQUES ET BIOLOGIQUES 1958; 3:884-6. [PMID: 13614962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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Vitamin-D-resistant rickets with craniostenosis. Proc R Soc Med 1958; 51:740-1. [PMID: 13591293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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