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CASE REPORT
Severe, reversible dysphagia and malnutrition in a patient with tumour-induced hypophosphataemia
  1. Tone Ramsli1,
  2. Jørgen Valeur2,
  3. Mikkel Pretorius3,
  4. Per Gerlyng1
  1. 1Medical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
  2. 2Unger Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
  3. 3Department of Endocrinology, Oslo University Hospital Ulleval. Oslo, Oslo, Norway
  1. Correspondence to Tone Ramsli, tonemberge{at}gmail.com

Summary

Up to 20% of hospitalised patients may have low serum phosphate concentrations. In certain groups, such as patients with chronic alcohol overconsumption, severe trauma or sepsis, the prevalence may be 30%–50%. Profound hypophosphataemia is less common, but may lead to severe physiological disturbances. In rare cases, hypophosphataemia is caused by phosphaturic substances excreted from a tumour. Osteomalacia with chronic bone pain and fractures, as well as muscle weakness, is common in such patients. The tumours are often small and difficult to detect. Studies suggest that fibroblast growth factor 23 is a reliable marker for detection of these tumours. Persistent hypophosphatemia unresponsive to supplements should raise clinical alertness. With complete resection of the neoplasm, the symptoms rapidly reverse. If the tumour cannot be removed, treatment relies on supplementation with phosphate and active vitamin D compounds. We present a case report of a patient with severe hypophosphataemia, osteomalacia, dysphagia and malnutrition.

  • malnutrition
  • calcium and bone
  • renal medicine
  • endocrinology
  • gastroenterology
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Footnotes

  • Contributors All authors have participated in writing the article. We have all treated the patient during investigations, treatment or follow-up. We have discussed the case through several meetings. JV and MP have contributed with important findings during both investigation, treatment and follow-up. PG has also contributed with excellent expertise as a senior physician. TR, the first author, has been responsible for connecting all contributions together.

  • 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.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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