A Normal <scp>FGF23</scp> Does Not Preclude Tumor‐Induced Osteomalacia

Nandam, Neeharika; Ejaz, Sadia; Ahrens, William A.; Styner, Martin

doi:10.1002/jbm4.10438

Cited by 4 publications

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References 27 publications

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“…Prolonged bisphosphonate use has also been associated with the risk of developing stress fractures [ 13 ]. Our patient had persistent non-healing fractures after vitamin D and calcium supplementation indicative of an additional underlying condition [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Phosphaturic Mesenchymal Tumor: An Unusual Cause of Stress Fractures Presenting to Sports Medicine

Solaiman¹,

Ogilvie²

2022

Cureus

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Phosphaturic mesenchymal tumors (PMT) are a rare neoplasm oftentimes associated with tumor-induced osteomalacia (TIO). The non-specific presentation and symptoms of these pathologies make them difficult to diagnose. We report a case of a 52-year-old patient with an intermetatarsal phosphaturic mesenchymal tumor who presented to the orthopedic sports medicine clinic with metabolic deficiencies and bilateral subtrochanteric cortical stress fractures indicative of osteomalacia. The tumor was entirely resected within nine months of symptom onset and has shown no recurrence at the one-year follow-up. This case report characterizes an unusual cause of stress fractures presenting to orthopedic sports medicine clinics and the variability in the presentation of phosphaturic mesenchymal tumors.

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Section: Discussionmentioning

confidence: 99%

Phosphaturic Mesenchymal Tumor: An Unusual Cause of Stress Fractures Presenting to Sports Medicine

Solaiman¹,

Ogilvie²

2022

Cureus

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Testosterone

2021

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Tumor-induced Osteomalacia: A Comprehensive Review

et al. 2022

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Tumor-induced osteomalacia (TIO) is an ultrarare paraneoplastic syndrome due to overproduction of fibroblast growth factor 23 (FGF23), with profound effects on the morbidity of the patients affected. TIO is an underdiagnosed disease, whose awareness should be increased among physicians, for timely and proper management of the patients. Symptoms reported by patients with TIO are usually nonspecific thus rendering the diagnosis elusive, with an initial misdiagnosis rate of >95%. Biochemical features of TIO are represented by hypophosphatemia, increased or inappropriately normal levels of FGF23 and low to low normal circulating 1,25(OH)2D. Phosphaturic mesenchymal tumors are the pathological entities underlying TIO in most affected patients. There is now evidence that FN1-FGFR1 and FN1-FGF1 fusion genes are present in about half of tumors causing this paraneoplastic syndrome. Tumors causing TIO are often of small size and grow slowly. They can occur in all parts of the body from head to toe with similar prevalence in soft tissue and bone. There are a number of functional and anatomical imaging techniques utilized for tumor localization; 68Ga DOTA based technologies have the better sensitivity. Surgery is the treatment of choice; several medical treatments are now available in case of inability to locate the tumor or in case of incomplete excision.

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A Normal FGF23 Does Not Preclude Tumor‐Induced Osteomalacia

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 4 publications

References 27 publications

Phosphaturic Mesenchymal Tumor: An Unusual Cause of Stress Fractures Presenting to Sports Medicine

Phosphaturic Mesenchymal Tumor: An Unusual Cause of Stress Fractures Presenting to Sports Medicine

Testosterone

Tumor-induced Osteomalacia: A Comprehensive Review

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