Tumor-induced osteomalacia: successful treatment by radio-guided tumor surgery

Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases
Birgit HarbeckHeiner Mönig

Abstract

Tumor-induced osteomalacia is a rare syndrome characterized by urinary phosphate loss with hypophosphatemic osteomalacia. The proposed pathogenetic mechanism is paraneoplastic secretion of phosphaturic factors (so-called phosphatonins).We describe a 34-year-old male patient who presented with severe pain of the spine and ribs for at least 2 years. Bone scintigraphy using Technetium hydroxymethylene diphosphonate (Tc HDP) showed multiple lesions suggesting metastatic disease. Bone biopsy however revealed osteomalacia. The patient had subnormal plasma phosphate levels (0.42 mmol/L; normal range, 0.87-1.45) and markedly increased phosphate clearance (82.8 mL/min; normal range, 5.4-16.2). The patient was treated with phosphate supplementation (up to 5 g daily) along with calcium (1000 mg daily) and calcitriol (1.5 microg daily). Although this therapy did not correct hypophosphatemia, it resulted in complete relief of pain within several months. (111)In pentetreotide scintigraphy showed a tiny lesion of 1-cm diameter, which could be localized to the left femoral neck in close vicinity to the greater trochanter by MRI and image fusion analysis. This lesion had not been visualized by Tc-99m HDP bone scintigraphy. Intraoperatively, use...Continue Reading

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Citations

Jul 27, 2011·Rheumatology International·Wang Xian-LingMu Yi-Ming
Apr 15, 2011·Endocrine-related Cancer·William H ChongMichael T Collins
Apr 26, 2012·Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research·Yan JiangXun-wu Meng
Oct 19, 2013·Experimental and Therapeutic Medicine·Min WangBingzhen Cao

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