Abstract
Background A previously healthy 32-year-old man presented with pain in his chest, ankle, and hip. His musculoskeletal pain progressed over the course of 6 months to the point of difficulty with ambulation.
Investigations Radiographic studies included chest and ankle X-rays, multiple bone scans, and foot and pelvic MRI. Laboratory evaluation comprised a serum chemistry panel (including electrolyte levels, renal function tests and liver function tests), and measuring serum levels of phosphorus, parathyroid hormone, vitamin D, alkaline phosphatase, and fibroblast growth factor 23, as well as urine levels of calcium and phosphorus.
Diagnosis Tumor-induced osteomalacia.
Management The patient received phosphate and vitamin D supplementation in the form of potassium-phosphorus (500 mg, three times daily) and calcitriol (0.5 µg, three times daily). Six months after his first presentation, he underwent surgical resection of a rib mass, with subsequent normalization of phosphorus concentration.
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References
Kumar R (2000) Tumor-induced osteomalacia and the regulation of phosphate homeostasis. Bone 27: 333–338
Jan de Beur SM (2005) Tumor-induced osteomalacia. JAMA 294: 1260–1267
Berndt TJ et al. (2005) “Phosphatonins” and the regulation of phosphorus homeostasis. Am J Physiol Renal Physiol 289: F1170–F1182
Shimada T et al. (2004) FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis. J Bone Miner Res 19: 429–435
Shimada T et al. (2001) Cloning and characterization of FGF23 as a causative factor of tumor-induced osteomalacia. Proc Natl Acad Sci USA 98: 6500–6505
Jonsson KB et al. (2003) Fibroblast growth factor 23 in oncogenic osteomalacia and X-linked hypophosphatemia. N Engl J Med 348: 1656–1663
White KE et al. (2001) The autosomal dominant hypophosphatemic rickets (ADHR) gene is a secreted polypeptide overexpressed by tumors that cause phosphate wasting. J Clin Endocrinol Metab 86: 497–500
Imel EA et al. (2006) Sensitivity of fibroblast growth factor 23 measurements in tumor-induced osteomalacia. J Clin Endocrinol Metab 91: 2055–2061
Walton RJ et al. (1975) Normogram for derivation of renal threshold phosphate concentration. Lancet 7929: 309–310
Folpe AL et al. (2004) Most osteomalacia-associated mesenchymal tumors are a single histopathologic entity: an analysis of 32 cases and a comprehensive review of the literature. Am J Surg Pathol 28: 1–30
Jan de Beur SM et al. (2002) Localisation of mesenchymal tumours by somatostatin receptor imaging. Lancet 359: 761–763
Dupond JL et al. (2005) Oncogenic osteomalacia: diagnostic importance of fibroblast growth factor 23 and F-18 fluorodeoxyglucose PET/CT scan for the diagnosis and follow-up in one case. Bone 36: 375–378
Jan de Beur SM et al. (2002) Molecular pathogenesis of hypophosphatemic rickets. J Clin Endocrinol Metab 87: 2467–2473
Econs MJ et al. (1997) Autosomal dominant hypophosphatemic rickets/osteomalacia: clinical characterization of a novel renal phosphate-wasting disorder. J Clin Endocrinol Metab 82: 674–681
Paglia F et al. (2002) Octreotide for tumor-induced osteomalacia. N Engl J Med 346: 1748–1749
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Halperin, F., Anderson, R. & Mulder, J. Tumor-induced osteomalacia: the importance of measuring serum phosphorus levels. Nat Rev Endocrinol 3, 721–725 (2007). https://doi.org/10.1038/ncpendmet0639
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DOI: https://doi.org/10.1038/ncpendmet0639
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