Ray Sayantan, Chakraborty Partha Pratim, Biswas Kaushik, Beatrice Anne M, Ghosh Sujoy, Mukhopadhyay Satinath, Chowdhury Subhankar
Department of Endocrinology and Metabolism , Institute of Post Graduate Medical Education and Research (IPGMER) and SSKM Hospital , Kolkata , India.
Oxf Med Case Reports. 2015 Apr 21;2015(4):265-8. doi: 10.1093/omcr/omv031. eCollection 2015 Apr.
Authors describe a case of oncogenic osteomalacia in a 35-year-old man, who presented with a 2-year history of generalized pain and progressive weakness of lower limbs, eventually became bedbound. At admission, he had severe hip pain resulting from bilateral femoral neck fractures. Laboratory investigations revealed hypophosphatemia, hyperphosphaturia, normocalcemia, elevated alkaline phosphatase and normal serum levels of parathormone and 25-hydroxyvitamin D. Serum fibroblast growth factor 23 (FGF23) level was elevated. A radiographic skeletal survey showed osteoporosis and insufficiency fractures of the femoral neck. A whole-body functional imaging failed to reveal any areas of increased activity. However, on computed tomography and magnetic resonance imaging of the head and neck region, a tumor was discovered at left nasal cavity. The tumor was surgically removed. After surgery, his symptoms were relieved and biochemical parameters normalized. We stress that careful clinical examination including nose and paranasal sinuses may be rewarding in cases with hypophosphatemic osteomalacia.
作者描述了一例35岁男性的致癌性骨软化症病例，该患者有2年全身疼痛和下肢进行性无力病史，最终卧床不起。入院时，他因双侧股骨颈骨折而有严重的髋部疼痛。实验室检查显示低磷血症、高磷尿症、血钙正常、碱性磷酸酶升高，甲状旁腺激素和25-羟基维生素D血清水平正常。血清成纤维细胞生长因子23（FGF23）水平升高。X线骨骼检查显示骨质疏松和股骨颈不全骨折。全身功能成像未发现任何活性增加区域。然而，在头颈部区域的计算机断层扫描和磁共振成像中，在左侧鼻腔发现了一个肿瘤。该肿瘤通过手术切除。术后，他的症状得到缓解，生化指标恢复正常。我们强调，对于低磷性骨软化症患者，包括鼻腔和鼻窦在内的仔细临床检查可能会有所收获。
