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Review
. 2021 Nov 30;22(23):12975.
doi: 10.3390/ijms222312975.

Phosphate Metabolism and Pathophysiology in Parathyroid Disorders and Endocrine Tumors

Guido Zavatta  1 , Paola Altieri  1 , Giulia Vandi  1 , Valentina Vicennati  1 , Uberto Pagotto  1 , Fabio Vescini  2
Affiliations
Review

Phosphate Metabolism and Pathophysiology in Parathyroid Disorders and Endocrine Tumors

Guido Zavatta et al. Int J Mol Sci. .

Abstract

The advent of new insights into phosphate metabolism must urge the endocrinologist to rethink the pathophysiology of widespread disorders, such as primary hyperparathyroidism, and also of rarer endocrine metabolic bone diseases, such as hypoparathyroidism and tumor-induced hypophosphatemia. These rare diseases of mineral metabolism have been and will be a precious source of new information about phosphate and other minerals in the coming years. The parathyroid glands, the kidneys, and the intestine are the main organs affecting phosphate levels in the blood and urine. Parathyroid disorders, renal tubule defects, or phosphatonin-producing tumors might be unveiled from alterations of such a simple and inexpensive mineral as serum phosphate. This review will present all these disorders from a 'phosphate perspective'.

Keywords: endocrine tumor; hyperparathyroidism; hypoparathyroidism; osteomalacia; parathyroid hormone; phosphate.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Phosphate Physiology. Green lines are stimulatory pathways, while red lines stand for inhibitory pathways. This figure can also be used to interpret diseases with PTH or FGF-23 excess or deficiency, or in case of abnormalities in phosphate cotransporters. Legend: CYP27B1, 1-alpha hydroxylase; CYP24A1, vitamin D 24-hydroxylase; NaPi, sodium-phosphate cotransporter.
Figure 2
Figure 2
Flowchart for evaluating patients presenting with low serum phosphate (hypophosphatemia). High TmP/GFR is indicative of high renal reabsorption of phosphate, which is appropriate in case of low intake or malabsorption. When TmP/GFR is inappropriately low in the setting of hypophosphatemia, this suggests renal phosphate wasting. Legend: TmP/GFR, maximum tubular reabsorption of phosphate corrected for glomerular filtration rate.
See this image and copyright information in PMC

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MeSH terms