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Osteoporosis International

, Volume 28, Issue 7, pp 2187–2193 | Cite as

Tumor-induced osteomalacia: experience from a South American academic center

  • G. González
  • R. Baudrand
  • M. F. Sepúlveda
  • N. Vucetich
  • F. J. Guarda
  • P. Villanueva
  • O. Contreras
  • A. Villa
  • F. Salech
  • L. Toro
  • L. Michea
  • P. FlorenzanoEmail author
Original Article

Abstract

Summary

The majority of tumor-induced osteomalacia cases have been reported in the Northern Hemisphere and Asia. In this first series of South American patients, we show that the clinical presentation and sensitivity of plasmatic fibroblast growth factor 23 and somatostatin analog-based imaging are similar to those described in other populations.

Introduction

Describe the experience of clinical presentation, diagnostic study, and treatment of patients with tumor-induced osteomalacia (TIO) in a South American academic center in comparison to literature.

Methods

Analysis of the records of patients diagnosed with TIO. The clinical presentation, diagnostic studies, and treatment were analyzed. Fibroblast growth factor 23 (FGF23) was measured by ELISA.

Results

Six patients were diagnosed with TIO during the studied period. The patients’ median age was 53 years (range 22–64). All patients presented with weakness and pain in the extremities. Four experienced fractures during their evolution. The median time to diagnosis was 4.5 years (1–20). Biochemical studies showed hypophosphatemia, median of 1.4 mg/dL (1.2–1.6), with low maximum rates of tubular reabsorption of phosphate adjusted for glomerular filtration rate. FGF23 was elevated in 4/6 patients and inappropriately normal in the other two. In three patients, the location of the tumor was clinically evident and confirmed with anatomical imaging. In the remaining patients, two tumors were located with 68Ga DOTATATE-PET/CT and one with OctreoScan. The causal tumors were located in the lower extremities in five patients and invading the frontal sinus in one patient. In all patients, tumors were successfully removed. Within 14 days, there was normalization of phosphate and FGF23 levels and resolution of clinical symptoms in all patients. In all cases, the histopathology was compatible with a phosphaturic mesenchymal tumor.

Conclusions

The clinical presentation, delay time to diagnosis, FGF23 diagnostic sensitivity and histopathology in this first series of South American patients is similar to those described in other populations. The success of localization by somatostatin analog-based imaging, suggests this may the optimal imaging modality.

Keywords

68Ga PET/CT FGF23 Hypophosphatemia Osteomalacia Tumor-induced osteomalacia 

Notes

Acknowledgments

We thank the support of the Research Direction of the Faculty of Medicine, Pontificia Universidad Catolica de Chile in the preparation of this manuscript.

Compliance of ethical standards

Conflict of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • G. González
    • 1
  • R. Baudrand
    • 1
  • M. F. Sepúlveda
    • 1
  • N. Vucetich
    • 1
  • F. J. Guarda
    • 1
  • P. Villanueva
    • 2
  • O. Contreras
    • 3
  • A. Villa
    • 4
  • F. Salech
    • 5
    • 6
  • L. Toro
    • 5
    • 6
  • L. Michea
    • 5
  • P. Florenzano
    • 1
    Email author
  1. 1.Departamento de Endocrinología, Escuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
  2. 2.Departamento de Neurocirugía, Escuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
  3. 3.Departamento de Radiología, Escuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
  4. 4.Departamento de Traumatología, Escuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
  5. 5.Instituto de Ciencias Biomédicas, Hospital Clinico Universidad de Chile, Facultad de MedicinaUniversidad de ChileSantiagoChile
  6. 6.Centro de Investigacion Clinica Avanzada, Hospital Clinico Universidad de Chile, Facultad de MedicinaUniversidad de ChileSantiagoChile

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