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Tumor-induced osteomalacia diagnostic algorithm

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Legend: 1,25(OH)2D, 1,25-dihydroxyvitamin D; 25(OH)D, 25-hydroxyvitamin D; ALP, alkaline phosphatase; FGF23, fibroblast growth factor 23; PTH, parathyroid hormone. (a) Perform genetic testing before imaging in children, young adults, or those with suggestive family history. (b) Perform genetic testing in adults without family history and negative functional imaging. (Source: Jan de Beur SM, Minisola S, Xia WB, et al. Global guidance for the recognition, diagnosis, and management of tumor-induced osteomalacia. J Intern Med 2023;293[3]:309-28.)

Figure adapted from:
Minisola S, Peacock M, Fukumoto S, et al. Tumour-induced osteomalacia. Nat Rev Dis Primers 2017;3:17044.
Courbebaisse M, Lanske B. Biology of fibroblast growth factor 23: from physiology to pathology. Cold Spring Harb Perspect Med 2018;8[5]:a031260.
Saraff V, Nadar R, Högler W. New Developments in the treatment of X-linked hypophosphataemia: implications for clinical management. Paediatr Drugs 2020;22[2]:113-21. Creative Commons Attribution [CC-BY] license, creativecommons.org/licenses/by/2.0.)