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Updated: May 5, 2026
Models of Bone Metastasis
Published on: September 4, 2012
Tumor(s) induced osteomalacia--a curious case of double trouble
Jayaprakash Sahoo1, Karthik Balachandran, Sadishkumar Kamalanathan
1Departments of Endocrinology (J.S., K.B., S.K., A.K.D.), Orthopedics (D.K.P.), Nuclear Medicine (D.H.), and Pathology (B.B.), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
Context:
We report a case of tumor-induced osteomalacia with evidence of synchronous multifocal fibroblast growth factor 23 (FGF23) production.
Objective:
The aim is to present a case of tumor-induced osteomalacia and to highlight the fact that incomplete removal of multifocal FGF23-producing tumors, which are not entirely picked up by functional imaging, could be the cause of treatment failure.
Setting:
The patient was treated in the Department of Endocrinology of a tertiary care center in India.
Patient:
We report the case of a 42-year-old male with tumor-induced osteomalacia.
Intervention:
We treated the tumor-induced osteomalacia with staged surgery of the two tumors. The 18F-fluorodeoxyglucose (FDG)-avid lesion (considered the sole culprit lesion after functional imaging) was resected first, followed by the non-FDG-avid lesion. The sequential removal of both tumors resulted in complete cure.
Results:
The patient had hypophosphatemia and hyperphosphaturia. C-Terminal FGF23 level was elevated. Positron emission tomography-computed tomography showed two lesions-an FDG-avid lesion in the right leg, and a non-avid lesion in the left thigh. After removal of the FDG-avid lesion, the hypophosphatemia persisted, and the FGF23 level showed only modest reduction. The patient had complete clinical and biochemical resolution only after removal of the second non-FDG-avid tumor.
Conclusions:
We present the case of a tumor-induced osteomalacia whose biochemical parameters did not improve after removal of the FDG-avid tumor initially. The possibility of multifocal FGF23 production was considered, and the second, non-FDG-avid lesion was resected, which resulted in complete cure. Thorough clinical examination and meticulous follow-up with documentation of the biochemical resolution are necessary for management of all patients with this rare disorder.
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