ENPP1 and neoplasm: Previous research indicated PET/CT with 68 Ga-DOTATATE as the first recommendation,[14,15] which showed very high sensitivity (87.5%) to detect tumors regardless of tumor size.[9] Nevertheless, we have received 3 adults presented as high FGF23 related hypophosphatemic osteomalacia with no mutation in the dmp-1, enpp1, fgf23, phex, and slc34a3 genes in the past 2 years.