Citation

Seemann LR, Padala SA, Mohammed A, Belayneh N. J. Investig. Med. High Impact Case Rep. 2019; 7: e2324709619895162.

Copyright

(Copyright © 2019, American Federation for Medical Research, Publisher SAGE Publishing)

DOI

10.1177/2324709619895162

PMID

31850815

PMCID

PMC6923526

Abstract

Tumor-induced osteomalacia is a rare hypophosphatemic disease caused by unregulated production of fibroblast growth factor 23 by a tumor, thereby inducing renal phosphate wasting and inhibiting appropriate increase of calcitriol production. Symptoms of tumor-induced osteomalacia, including muscle weakness, bone pain, and pathologic fractures, are nonspecific and warrant further workup. We report the case of a 50-year-old African American female with no known psychiatric illness who was admitted after a failed suicide attempt provoked by severe bone pain. She had been treated for fibromyalgia and hypophosphatemic rickets at other facilities with no improvement. The findings of profound renal phosphate wasting initiated further evaluation, which revealed an elevated fibroblast growth factor 23 level and a right proximal fibular mesenchymal tumor on octreotide scintigraphy. Magnetic resonance imaging confirmed the findings of a solid intramuscular tumor corresponding to the octreotide avid lesion. After wide excision of the tumor, serum phosphate and parathyroid hormone levels began to normalize. This case highlights the importance of extensively investigating the cause of bone pain, weakness, and fatigue in patients without a family history of hypophosphatemia or bone disorders. The aforementioned symptoms may precede recurrent pathological fractures, and a thorough workup ensures that a diagnosis of tumor is not delayed or overlooked, as tumor resection confers a favorable prognosis and dramatic increase in the quality of life for patients.

Language: en

Keywords

Humans; Female; Middle Aged; Magnetic Resonance Imaging; Suicide, Attempted; Pain; Fibromyalgia; osteomalacia; hypophosphatemia; Phosphates; Delayed Diagnosis; Radionuclide Imaging; Hypophosphatemia; Paraneoplastic Syndromes; FGF23; fibroblast growth factor 23; Fibroblast Growth Factor-23; Fibroblast Growth Factors; Neoplasms, Connective Tissue; octreotide scintigraphy; Osteomalacia; paraneoplastic syndromes; phosphaturic mesenchymal tumor; renal phosphate wasting; Rickets, Hypophosphatemic; tumor-induced osteomalacia