Case Report of Tumour-induced Osteomalacia with Parotid Gland Tumour as a Focus
Keywords:TIO, Hypophosphatemia, FGF-23
Tumour-induced osteomalacia (TIO) is a rare paraneoplastic syndrome, which is characterized by overproduction of FGF23 as a phosphaturic agent leading to chronic phosphaturia and hypophosphatemia, associated with inappropriately normal or low levels of vitamin D. We describe a rare case of a 57-year-old Indian female who presented with bone pains, muscle pains and lower limb weakness. On examination she was found to have hypophosphatemia. Our work up led to the identification of a FGF23 secreting parotid tumour. The tumour responsible for symptoms was a pleomorphic adenoma of the parotid gland. Its complete resection resulted in normalisation of patient's symptoms. Laboratory parameters and microsopic examination further revealed a mesenchymal tumour of mixed connective tissue type.
Bringhurst F, Demay MB, Krane SM, Kronenberg HM. Disorders of bone and mineral metabolism. In: Harrison's Principles of Internal Medicine, 19th edition. New York: McGraw Hill; 2012.
Larsson T, Marsell R, Schipani E, et al. Transgenic mice expressing fibroblast growth factor 23 under the control of α1(I) collagen promoter exhibit growth retardation, osteomalacia, and disturbed phosphate homeostasis. Endocrinology. 2004;145(7):3087-94. https://doi.org/10.1210/en.2003-1768#sthash.PL1RQgCp.dpuf.
Shimada T, Hasegawa H, Yamazaki Y, et al. FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis. J Bone Miner Res. 2004;19(3):429-35. https://doi.org/10.1359/JBMR.0301264.
Kumar R. Tumor-induced osteomalacia and the regulation of phosphate homeostasis. Bone. 2000;27(3):333-8. https://doi.org/10.1016/S8756-3282(00)00334-3.
Jan de Beur SM. Tumor-induced osteomalacia. JAMA. 2005;294(10):1260-7. https://doi.org/10.1001/jama.294.10.1260.
Berndt TJ, Schiavi S, Kumar R. "Phosphatonins" and the regulation of phosphorous homeostasis. Am J Physiol Renal Physiol. 2005;289(6):F1170-82. https://doi.org/10.1152/ajprenal.00072.2005.
Shimada T, Mizutani S, Muto T, Yoneya T, Hino R, Takeda S, et al. Cloning and characterization of FGF23 as a causative factor of tumor induced osteomalacia. Proc Nati Acad Sci USA. 2001; 98(11):6500-5. https://doi.org/ 10.1073/pnas.101545198.
White KE, Bringhurst R, Econs MJ. Genetic disorders of phosphate homeostasis. In: J Larry Jameson, Leslie De Groot DM De Kretser. Endocrinology: Adult and Pediatric. Philadelphia: Elsevier/Saunders; 2010.
Chalew SA, Lovchik JC, Brown CM, Sun CCJ. Hypophosphatemia induced in mice by transplantation of a tumor-derived cell line from a patient with oncogenic rickets. J Paediatr Endocrinol Metab. 1996;9(6):593-7. https://doi.org/10.1515/JPEM.19184.108.40.2063.
Folpe AL, Fanburg-Smith JC, Billings SD, Bisceglia M, Bertoni F, Cho JY, et al. Most osteomalacia-associated mesenchymal tumors are a single histopathologic entity: An analysis of 32 cases and a comprehensive review of literature. Am J Surg Pathol. 2004;28(1):1-30. PMID: 14707860.
Halperin F, Anderson RJ, Mulder JE. Tumor-induced osteomalacia: The importance of measuring serum phosphorus levels. Nat Clin Pract Endocrinol Metab. 2007;3(10):721-5. https://doi.org/10.1038/ncpendmet0639
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