Edit concept Question Editor Create issue ticket

Oncogenic Osteomalacia

TIO


Presentation

  • We examined the case records of a 55-year-old man who presented with progressive fatigue, weakness and bone pain, and noted the clinical presentation, laboratory investigations, computed tomography findings, operative notes and follow-up details.[ncbi.nlm.nih.gov]
Soft Tissue Mass
  • Although oncogenic osteomalacia was suspected, cranial, chest, and abdominal computed tomography scanning, urological and otolaryngological examinations, and detailed palpation for soft tissue mass failed to detect the responsible tumor.[ncbi.nlm.nih.gov]
  • Matrix Enter text Cortex Enter text Soft tissue mass Enter text Laboratories Elevated Fibroblast growth factor 23 (FGF-23) Normal or low serum calcium Normal intact PTH Normal 25 (OH) Vit D Low 1,25 (OH)2 Vit D (Secondary to effects of FDF-23) Hyperphosphaturia[orthopaedicsone.com]
  • Note the soft tissue mass protruding from the middle portion of the left mandible. Fig. 2. Histologic sections of the iliac bone biopsy specimen.[kjim.org]
Wheelchair Bound
  • bound incapacitated state of 1-year duration.[ncbi.nlm.nih.gov]
  • Two years after onset, he required the assistance of a rolling walker, and within 4 years, he became wheelchair bound and had developed weakness of his shoulder girdle and arms. Prior outside neuromuscular evaluation revealed no specific diagnosis.[neurology.org]
  • Patient and methods: 41- year gentleman with 4-year history of musculoskeletal weakness and pathologic fractures presented in wheelchair bound incapacitated state of 1-year duration.[journals.viamedica.pl]
  • Severe disease may result in numerous insufficiency fractures and render the patient wheelchair-bound. Pathology Tumor-induced osteomalacia can be caused by a variety of tumors, however they are usually benign bone or soft tissue tumors.[orthopaedicsone.com]
Severe Pain
  • A 60-year-old woman complained of severe pain in her back and chest wall, muscle weakness, and reduced physical activity for 1 year. She suffered a metatarsal fracture and presented with hyperphosphaturia and hypophosphatemia.[ncbi.nlm.nih.gov]
  • Patients with oncogenic osteomalacia frequently present with fractures and more severe pain than that in hypophosphatemic osteomalacia, which it resembles. They also may report muscle weakness.[healio.com]
  • The patient is a 62-year-woman who presented to me in 2001 with multiple rib fractures resulting in severe pain.[endotext.org]
  • For the past 2 years, he was bedridden due to severe pain. Weakness of the bones had led to convex deformities of the left upper arm and pectus excavatum.[ijaweb.org]
Lower Extremity Pain
  • A 46-year-old man was examined for chronic hip and lower extremity pain that had not been relieved by nonsteroidal anti-inflammatory drugs or steroids. A bone scan revealed multiple foci of activity.[ncbi.nlm.nih.gov]
Acute Abdomen
  • Associating these sequels to the fact that the patient acquired sepsis by urinary infection on Intensive Care Unit, she evolved to an acute abdomen by hypomotility, without obstructive factor by CT.[ncbi.nlm.nih.gov]
Leg Pain
  • A 45-year-old male was admitted with difficulty in walking due to leg pain. At the time of the first visit, a reduced serum phosphorus concentration and an increased serum alkaline phosphatase concentration of unknown etiology were observed.[ncbi.nlm.nih.gov]
  • Patient 2 A 60‐yr‐old woman was referred to the metabolic unit in 1979 with a 5‐yr history of bilateral foot and diffuse left leg pain for which she had seen four physicians.[academic.oup.com]
Incontinence
  • In the patient's last follow-up, we diagnosed a generalized dysfunction of the neuromuscular synapses that aggravated his myopathy due to chronic hypophosphatemia and caused urinary incontinence.[edmcasereports.com]

Workup

  • Workup included vitamin D deficiency/resistance, renal tubular acidosis and malabsorption all of which were negative. To evaluated for a paraneoplastic cause and blood pool scintigraphy was done.[radiopaedia.org]
  • She underwent conservative treatment and diagnostic workup. She was diagnosed as osteomalacia and took calcium and phosphate. On past medical history, the patient underwent a endoscopic surgery for sinusitis with polyp at 7 years ago.[e-ceo.org]
  • However, since the condition is a rare cause of osteomalacia, a full baseline biochemical osteomalacia workup should precede FGF23 testing.[mayomedicallaboratories.com]
  • Further workup yielded a high FGF-23 level and computed tomography of the paranasal sinuses showed a soft tissue tumour in the left ethmoidal sinus ( Fig 2 ). Table. Biochemical parameters Figure 1.[hkmj.org]
  • When a tumour is surgically unresectable or not localised after an extensive workup, oral combined with phosphate treatment, calcium, and calcitriol is recommended, along with phosphate monitoring, a treatment similar to that used in the genetics forms[touchendocrinology.com]
Hyponatremia
  • Therefore, renal wasting hypophosphatemia with concomitant SIADH/hyponatremia should prompt a search for SCC rather than a benign mesenchymal tumor.[ncbi.nlm.nih.gov]

Treatment

  • The median duration of symptoms before definitive surgical treatment was 6 years, and in one patient was more than 10 years.[ncbi.nlm.nih.gov]

Prognosis

  • This case suggests that TIO has a dismal prognosis in prostate cancer patients. The clinical oncology community must be aware about such disturbance that can be present in those patients with weakness, bone pain, and hypophosphatemia.[ncbi.nlm.nih.gov]
  • Prognosis Excellent recovery after complete tumor excision with complete resolution of symptoms and biochemical abnormalities. Long term monitoring is required as local recurrence and metastases have been reported, even if rarely.[orpha.net]
  • Prognosis • The prognosis for a treatable and usually transient cause of hypophosphatemia is excellent.[slideshare.net]
  • Thus, these tumors need special reference as they show a questionable prognosis and, by histological investigations, it cannot be decided if we are dealing with a benign or malignant tumor growth.[ijnm.in]

Etiology

  • At the time of the first visit, a reduced serum phosphorus concentration and an increased serum alkaline phosphatase concentration of unknown etiology were observed.[ncbi.nlm.nih.gov]
  • Etiology This syndrome is caused by phosphatonin secretion by the causative tumor.[orpha.net]

Epidemiology

  • Introduction Definition paraneoplastic syndrome of renal phosphate wasting caused by bone tumor or soft tissue tumor Epidemiology demographics age bracket age of onset is late childhood to early adulthood Pathophysiology the tumor secretes a humoral factor[orthobullets.com]
  • Summary Epidemiology The prevalence of the disease is not known. Since the association between phosphate reabsorption and tumor was first made, approximately 400 cases of oncogenic osteomalacia have been reported in the literature.[orpha.net]
  • […] defects in phosphate metabolism: high remodelling rate: excessive osteoid formation with normal/little mineralisation low remodelling rate: normal osteoid production with diminished mineralisation Because of the many causes of osteomalacia worldwide, the epidemiology[radiopaedia.org]
Sex distribution
Age distribution

Pathophysiology

  • New insight into the pathophysiology of oncogenic osteomalacia is also presented.[ncbi.nlm.nih.gov]
  • Pathophysiology It has been clear for a long time that a humoral substance caused the osteomalacia, because the bone disease resolves when the tumors are resected.[courses.washington.edu]
  • Objective: To present a rare case of oncogenic osteomalacia, describe the breadth of potential clinical symptoms, and review the underlying pathophysiology of this disorder.[journals.aace.com]
  • Introduction Definition paraneoplastic syndrome of renal phosphate wasting caused by bone tumor or soft tissue tumor Epidemiology demographics age bracket age of onset is late childhood to early adulthood Pathophysiology the tumor secretes a humoral factor[orthobullets.com]

Prevention

  • Resection of the cervical lesion led to resolution of his hypophosphatemia and prevention of any further pathological fractures.[ncbi.nlm.nih.gov]
  • Ovarian ablation may be used to prevent and treat breast cancer.[cancer.gov]
  • Unfortunately, there are no consensus about the area of wide resection margin on the previous literature, however we believe that the tumor must be surgically excised with a wide margin of resection to prevent recurrences.[e-ceo.org]
  • Serum phosphate and calcium levels should be monitored every 6 hours to ensure maintenance of normal calcium levels and to prevent overcorrection of phosphate deficiency. 48.[slideshare.net]
  • In the PACU, adequate analgesia was provided, prevention of deep venous thrombosis ensured and close monitoring for hypo- and hyper-calcaemia was done.[ijaweb.org]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!