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Oncogenic osteomalacia: two case reports with surprisingly different outcomes.
Roberto Seijas1, Oscar Ares, Judit Sierra
1Fundación García Cugat-Hospital Quiron, Cirugía Ortopédica y Traumatología, planta-1, Pza. Alfonso Comín 5-7, Barcelona 08023, Spain. roberto6jas@gmail.com
Archives of Orthopaedic and Trauma Surgery
|January 7, 2009
Summary
Oncogenic osteomalacia, a rare condition linked to fibroblast growth factor 23 (FGF23), causes phosphate loss. Surgical tumor removal often cures it, but alternative treatments exist if resection isn't possible.
Area of Science:
- Endocrinology
- Oncology
- Nephrology
Background:
- Oncogenic osteomalacia is a rare paraneoplastic syndrome characterized by acquired hypophosphatemic osteomalacia.
- It stems from impaired renal tubular phosphate reabsorption, with fibroblast growth factor 23 (FGF23) playing a key role.
- The condition is typically linked to phosphaturic mesenchymal tumors in bone or soft tissue.
Observation:
- Clinical and radiological findings mimic general osteomalacia.
- Biochemical markers include renal phosphate wasting, low serum phosphate, and reduced 1,25-(OH)2D3 levels.
- Normal levels of calcium, PTH, calcitonin, 25-OH-D3, and 25,25-(OH)2D3 are noted.
Findings:
- Two cases of oncogenic osteomalacia associated with phosphaturic mesenchymal tumors are presented.
- The first patient experienced tumor removal and symptom resolution.
- The second patient had a liver tumor; resection was unsuccessful, leading to multiple lesion development.
Implications:
- Complete tumor resection usually leads to disease remission.
- If resection is not feasible, treatment with oral phosphate, calcium, and calcitriol can alleviate symptoms.
- Somatostatin analog therapy may stabilize lesions in patients with octreotide receptors on tumor scintigraphy.
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