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Tumor-induced osteomalacia: the importance of measuring serum phosphorus levels

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 721–725 (2007)Cite this article

Abstract

Background A previously healthy 32-year-old man presented with pain in his chest, ankle, and hip. His musculoskeletal pain progressed over the course of 6 months to the point of difficulty with ambulation.

Investigations Radiographic studies included chest and ankle X-rays, multiple bone scans, and foot and pelvic MRI. Laboratory evaluation comprised a serum chemistry panel (including electrolyte levels, renal function tests and liver function tests), and measuring serum levels of phosphorus, parathyroid hormone, vitamin D, alkaline phosphatase, and fibroblast growth factor 23, as well as urine levels of calcium and phosphorus.

Diagnosis Tumor-induced osteomalacia.

Management The patient received phosphate and vitamin D supplementation in the form of potassium-phosphorus (500 mg, three times daily) and calcitriol (0.5 µg, three times daily). Six months after his first presentation, he underwent surgical resection of a rib mass, with subsequent normalization of phosphorus concentration.

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Figure 1: Chest X-ray of the patient at initial presentation.
Figure 2: Bone scans of the patient when first tested and 3 months later.

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Author information

Authors and Affiliations

  1. F Halperin is a Fellow in Endocrinology at Brigham and Women's Hospital of Harvard Medical School, Boston, MA, USA.,

    Florencia Halperin

  2. RJ Anderson is an Associate Professor of Medicine at Harvard Medical School and a Rheumatologist at Brigham and Women's Hospital.,

    Ronald J Anderson

  3. JE Mulder is an Instructor in Medicine at Harvard Medical School and an Endocrinologist at Brigham and Women's Hospital and Dana–Farber Cancer Institute, Boston, MA, USA.,

    Jean E Mulder

Authors
  1. Florencia Halperin
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  2. Ronald J Anderson
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  3. Jean E Mulder
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Corresponding author

Correspondence to Florencia Halperin.

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The authors declare no competing financial interests.

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Halperin, F., Anderson, R. & Mulder, J. Tumor-induced osteomalacia: the importance of measuring serum phosphorus levels. Nat Rev Endocrinol 3, 721–725 (2007). https://doi.org/10.1038/ncpendmet0639

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  • DOI: https://doi.org/10.1038/ncpendmet0639

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