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Tumor-Induced Osteomalacia and the Importance of Plasma Fibroblast Growth Factor 23 as an Indicator: Diagnostic Delay Leads to a Suicide Attempt
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Journal Article
Tumor-Induced Osteomalacia and the Importance of Plasma Fibroblast Growth Factor 23 as an Indicator: Diagnostic Delay Leads to a Suicide Attempt
2019
Overview
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.
Publisher
SAGE Publications,SAGE Publishing
Subject
