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Tumour-induced osteomalacia due to residual benign glomangioma
  1. Rakhee Barai1,
  2. Tiffany Tsang2 and
  3. Lissette Cespedes2
  1. 1Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  2. 2Department of Endocrinology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to Dr. Rakhee Barai; rakheebarai{at}gmail.com

Abstract

Tumour-induced osteomalacia (TIO) is a rare paraneoplastic syndrome. The constellation of findings of unprovoked fractures, hypophosphataemia, urinary phosphate wasting and a negative genetic evaluation suggest a TIO diagnosis. Tumours leading to TIO are often small and difficult to localise using standard imaging studies. The 68Ga-DOTATATE CT/positron emission tomography, a somatostatin receptor imaging modality, is the radiographical study of choice for localisation. It is highly sensitive and specific since tumours that cause oncogenic osteomalacia have been shown to express somatostatin receptors. Complete surgical resection is the treatment of choice; however, it may not always be feasible. Burosumab, a human anti-fibroblast growth factor-23 monoclonal antibody, is a therapeutic option in cases of unresectable TIO to normalise phosphorus levels and improve fracture healing. Our patient was initiated on burosumab, which led to healing of his fractures and profound symptomatic improvement of his pain. TIO is often undiagnosed for many years, leading to significant patient morbidity.

  • endocrinology
  • drugs: endocrine system
  • musculoskeletal and joint disorders
  • calcium and bone

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Footnotes

  • Contributors Conception and design—TT and LC. Data acquisition/collection—RB, TT and LC. Data analysis and interpretation of data—RB, TT and LC. Writing publication—RB and TT. Critical revision of publication and approval of final publication—RB and LC. Supervision—LC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.