Oncogenic osteomalacia illustrating the effect of fibroblast growth factor 23 on phosphate homeostasis

Abstract

In oncogenic osteomalacia (OOM), fibroblast growth factor 23 (FGF23) induces renal phosphate wasting and inhibits the appropriate increase of calcitriol. A patient suffering from OOM is described. Serum calcium, phosphate, biointact parathyroid hormone and intact FGF23 as well as the calcitriol and 24,25-vitamin D levels were measured before and after tumour removal. The clinical approach to a patient with hypophosphataemia is discussed and the changes in mineral metabolism after removal of a FGF23-producing tumour are described.

Histopathological and genetic review of phosphaturic mesenchymal tumours, mixed connective tissue variant

“…FGF23 was first reported as a gene responsible for autosomal‐dominant hypophosphataemic rickets, and recently became widely accepted to encode a secreted protein that is particularly abundant in tumour‐associated osteomalacia cases . In the past, tumour‐associated osteomalacia was thought to be induced by several kinds of tumour, but a recent investigation revealed that almost all tumour‐induced osteomalacia cases were associated with a histologically definitive tumour entity, phosphaturic mesenchymal tumour, mixed connective tissue variant .…”

“…FGF23 was first reported as a gene responsible for autosomal-dominant hypophosphataemic rickets, 12 and recently became widely accepted to encode a secreted protein that is particularly abundant in tumour-associated osteomalacia cases. 6,13 In the past, tumour-associated osteomalacia was thought to be induced by several kinds of tumour, 14 but a recent investigation revealed that almost all tumour-induced osteomalacia cases were associated with a histologically definitive tumour entity, phosphaturic mesenchymal tumour, mixed connective tissue variant. 10 As to the metastatic potential of this condition, some metastatic cases were reported, 10,[15][16][17][18][19][20] but no comparative study was performed between metastatic and non-metastatic PMT-MCT cases with plural cases in the former group.…”

Tumor induced osteomalacia secondary to anaplastic thyroid carcinoma: A case report and review of the literature

“…TIO has been described in association with adenocarcinomas of the ovary, lung, prostate, colon and head/neck ( Fatani et al, 2013 , Westerberg et al, 2012 , Gandhi et al, 2012 , Jiang et al, 2012 , Gardner et al, 2013 , Hautmann et al, 2014 , Lin et al, 2014 , Taylor et al, 1984 , Lee et al, 2014 , Ryan and Reiss, 1984 , Tarasova et al, 2013 , Kominek et al, 2011 , Luo et al, 2013 , Mathis et al, 2013 ). There has been one case report of a patient with thyroid cancer presenting with TIO and bone metastasis.…”

“…Successful surgical resection of the FGF-23 secreting tumor is curative, thus accurate localization of the tumor is of the utmost importance ( Jonsson et al, 2003 ). The majority of the TIO cases previously reported in the literature have been caused by small mesenchymal tumors derived from bone ( Fatani et al, 2013 , Westerberg et al, 2012 , Gandhi et al, 2012 ), soft tissue ( Jiang et al, 2012 ), skin ( Gardner et al, 2013 ) and cartilage ( Hautmann et al, 2014 ). TIO has also been reported in association with malignant adenocarcinomas of the ovary ( Lin et al, 2014 ), lung ( Taylor et al, 1984 ), prostate ( Lee et al, 2014 ), colon ( Ryan and Reiss, 1984 ) and head/neck ( Tarasova et al, 2013 , Kominek et al, 2011 , Luo et al, 2013 , Mathis et al, 2013 ).…”