Successful Superficial Blood Sampling to Localize a Fibroblast Growth Factor-23-Producing Tumor

Junjiro Rikitake; Kenji Ashida; Ayako Nagayama; Yukihiro Inoguchi; Nao Hasuzawa; Masamichi Koganemaru; Tetsuya Hamada; Kanoko Moritaka; Mutsuyuki Demiya; Tomoki Sako; Jun Akiba; Koji Hiraoka; Masatoshi Nomura

doi:10.12659/AJCR.943152

13 April 2024 : Case report Japan

Successful Superficial Blood Sampling to Localize a Fibroblast Growth Factor-23-Producing Tumor

Challenging differential diagnosis, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Junjiro Rikitake^1ABCDEF, Kenji Ashida

^1ABCDEF*, Ayako Nagayama^1ACDEF, Yukihiro Inoguchi^1CDEF, Nao Hasuzawa^1CDEF, Masamichi Koganemaru^2BCDE, Tetsuya Hamada^3BCDE, Kanoko Moritaka^1BCDE, Mutsuyuki Demiya^1BCDE, Tomoki Sako^1BCDE, Jun Akiba^4BCDE, Koji Hiraoka^3BCDE, Masatoshi Nomura^1ACDEF

DOI: 10.12659/AJCR.943152

Am J Case Rep 2024; 25:e943152

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Introduction Case Report Discussion Conclusions References:

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Table 2. Examination of blood sampling methods from review of literature.



ACTH	Inferior petrosal sinus sampling	Prolactin	(With CRH stimulation) Central/Peripheral ratio ≥3 indicates central production (Without CRH stimulation) Central/Peripheral ratio ≥2 indicates central production	[,]⁷

Intact-PTH		None	Elevation in the intact-PTH level by ≥2 times than that in other peripheral veins indicates the drainage vein	[]¹⁴

Insulin	Selective arterial secretagogue injection (SASI) test	None	(Rapid gluconate calcium injection via branches of the celiac artery [gastroduodenal; splenic; and superior mesenteric arteries]) The substantial increase, after calcium injection, indicates the feeding artery of the insulinoma	[]⁹
Gastrin	Selective arterial secretagogue injection (SASI) test	None	(Rapid gluconate calcium injection via branches of the celiac artery [gastroduodenal; splenic; and superior mesenteric arteries]) The elevations in the gastrin level at either 20 or 40 s (>80 pg/mL and >20% from the basal level) indicate the feeding artery of the gastrinoma.	[]²²

Aldosterone		Cortisol	(Mostly with intravenous administration of ACTH) The (aldosterone/cortisol) values are used for the following investigations:	[,, ,]¹⁰
Testosterone		None	The sampling vein that shows the highest level is considered as the drainage vein A peripheral testosterone value ≥4.51 nmol/L (≥130 ng/dL) and R: L ovarian testosterone ratio ≥1.44	[,]¹²
Progesterone		None	The sampling vein exhibiting step-up of progesterone is considered as responsible site	[]¹³

FGF-23	• Principal veins (13 or 22 points) were listed for systemic exploration for detecting responsible tumor	None	The sampling point that shows discernibly elevated FGF-23 level indicates the presence of FGF-23-producing tumor in its distal region	[,, –]⁴
FGF-23 – fibroblast growth factor-23; ACTH – adrenocorticotropic hormone; PTH – parathyroid hormone; CT – computed tomography; MRI – magnetic resonance imaging.

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Successful Superficial Blood Sampling to Localize a Fibroblast Growth Factor-23-Producing Tumor

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