Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 30;24(1):687.
doi: 10.3390/ijms24010687.

Mild Hypophosphatemia-Associated Conditions in Children: The Need for a Comprehensive Approach

Pablo Docio  1 , Sandra Llorente-Pelayo  1 , María Teresa García-Unzueta  2 , Bernardo A Lavin-Gómez  2 , Nuria Puente  3 , Fátima Mateos  4 , Leyre Riancho-Zarrabeitia  5 , Domingo Gonzalez-Lamuño  1 , José A Riancho  3
Affiliations

Mild Hypophosphatemia-Associated Conditions in Children: The Need for a Comprehensive Approach

Pablo Docio et al. Int J Mol Sci. .

Abstract

To better understand the causes of hypophosphatemia in children, we evaluated all serum phosphate tests performed in a tertiary hospital with unexpected but persistent temporary or isolated hypophosphatemia over an 18 year period. We collected 29,279 phosphate tests from 21,398 patients, of which 268 (1.2%) had at least one result showing hypophosphatemia. We found that endocrinopathies (n = 60), tumors (n = 10), and vitamin D deficiency (n = 3) were the medical conditions most commonly associated with mild hypophosphatemia, but in many patients the cause was unclear. Among patients with endocrinopathies, those with diabetes mellitus were found to have lower mean serum phosphate levels (mean 3.4 mg/dL) than those with short stature (3.7 mg/dL) or thyroid disorders (3.7 mg/dL). In addition, we found a correlation between glycemia and phosphatemia in patients with diabetes. However, despite the potential relevance of monitoring phosphate homeostasis and the underlying etiologic mechanisms, renal phosphate losses were estimated in less than 5% of patients with hypophosphatemia. In the pediatric age group, malignancies, hypovitaminosis D, and endocrine disorders, mostly diabetes, were the most common causes of hypophosphatemia. This real-world study also shows that hypophosphatemia is frequently neglected and inadequately evaluated by pediatricians, which emphasizes the need for more education and awareness about this condition to prevent its potentially deleterious consequences.

Keywords: GH deficiency; diabetes mellitus; hypophosphatemia; short stature; thyroid disorders.

PubMed Disclaimer

Conflict of interest statement

J.A.R., D.G.-L., and N.P. have received research grants, speaking fees, or travel bursaries from Kyowa Kirin.

Figures

Figure 1
Figure 1
Distribution of serum phosphate results across the pediatric population.
Figure 2
Figure 2
Distribution of cases across subgroups according to the time course and the presence or absence of a hypophosphatemia-causing disorder.
Figure 3
Figure 3
Mean and standard deviation of serum phosphate in children with various endocrine disorders.
Figure 4
Figure 4
(a) Phosphorus-glucose correlation and (b) phosphorus-HbA1c correlation.
See this image and copyright information in PMC

References

    1. Florenzano P., Cipriani C., Roszko K.L., Fukumoto S., Collins M.T., Minisola S., Pepe J. Approach to patients with hypophosphataemia. Lancet Diabetes Endocrinol. 2020;8:163–174. doi: 10.1016/S2213-8587(19)30426-7. - DOI - PubMed
    1. Megapanou E., Florentin M., Milionis H., Elisaf M., Liamis G. Drug-Induced Hypophosphatemia: Current Insights. Drug Saf. 2020;43:197–210. doi: 10.1007/s40264-019-00888-1. - DOI - PubMed
    1. Imel E.A. Congenital Conditions of Hypophosphatemia in Children. Calcif Tissue Int. 2021;108:74–90. doi: 10.1007/s00223-020-00692-5. - DOI - PMC - PubMed
    1. Quarles L.D. FGF23, PHEX, and MEPE regulation of phosphate homeostasis and skeletal mineralization. Am. J. Physiol. Endocrinol. Metab. 2003;285:E1–E9. doi: 10.1152/ajpendo.00016.2003. - DOI - PubMed
    1. Kumar Shah S., Irshad M., Gupta N., Kumar Kabra S., Lodha R. Hypophosphatemia in Critically Ill Children: Risk Factors, Outcome and Mechanism. Indian J. Pediatr. 2016;83:1379–1385. doi: 10.1007/s12098-016-2188-x. - DOI - PubMed

Grants and funding