Hypophosphatemia: A Practical Guide to Evaluation and Management

Elsevier

Available online 6 August 2022

Endocrine PracticeHighlights•

Hypophosphatemia is a common clinical finding that is often overlooked leading to delayed diagnosis and significant morbidity when severe or long-standing.

The cause of hypophosphatemia consists of three major categories: inadequate intake, redistribution to the intracellular space, or renal phosphate loss.

Chronic hypophosphatemia leads to rickets in children and osteomalacia in adult.

Serum phosphate should be measured in all patients with unexplained musculoskeletal symptoms.

Abstract

Phosphate plays a critical and diverse role in human physiology. In addition to it is importance in skeletal mineralization, it is essential for energy homeostasis, enzyme function, and cell membrane integrity. These diverse functions of provide an explanation for the range of symptoms and clinical manifestations in patients with both acute and chronic causes of hypophosphatemia. Normal phosphate homeostasis involves several major systems including the gastrointestinal tract, bone, and the kidney. Phosphate balance is maintained directly and indirectly by the hormones 1α,25(OH)2D3, parathyroid hormone, and osteocyte derived phosphatonin, fibroblast growth factor 23. This review will discuss normal phosphate homeostasis, clinical manifestations and causes of hypophosphatemia, and an approach to establishing a diagnosis and appropriate management.

Key words

Hypophosphatemia

Fibroblast Growth Factor 23

Rickets

Osteomalacia

Vitamin D

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© 2022 AACE. Published by Elsevier Inc. All rights reserved.

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