Akbari Mojtaba, Larijani Bagher, Sharghi Sasan, Jalili Ali, Sajjadi-Jazi Sayed Mahmoud
Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
J Diabetes Metab Disord. 2017 Aug 23;16:34. doi: 10.1186/s40200-017-0315-5. eCollection 2017.
Tumor-induced osteomalacia is an uncommon paraneoplastic syndrome caused by Fibroblast growth factor-23-secreting tumors. It is characterized by phosphaturia, hypophosphatemia, and a high plasma level of alkaline phosphatase.
We report a young patient with psoriasis who had suffered from bone pain and muscle weakness for more than 6.5 years. He was finally diagnosed with tumor-induced osteomalacia. However, mistakenly attributing the patient's signs and symptoms to psoriatic arthritis for a long time had resulted in multiple complications for the patient. Finally, the tumor was localized and surgically resected. This resulted in clinical improvements and the resolution of all biochemical abnormalities.
To our knowledge, this is the second case of tumor-induced osteomalacia accompanied by psoriasis. There is growing evidence to suggest that Fibroblast growth factor-23 has a role in regulating immune function while an increased level of it may play a role in the pathogenesis of psoriasis. As a result, tumor-induced osteomalacia may affect the psoriasis clinical course by secreting a high amount of Fibroblast growth factor-23. On the other hand, several studies have showed an increased risk of malignancy among patients with psoriasis. Consequently, long-term psoriasis may predispose patients to Fibroblast growth factor-23-secreting tumors. Finally, as psoriasis is a common disease, this presentation may simply be a coincidence.
肿瘤诱导的骨软化症是一种由分泌成纤维细胞生长因子-23的肿瘤引起的罕见副肿瘤综合征。其特征为磷酸盐尿、低磷血症以及血浆碱性磷酸酶水平升高。
我们报告一名患有银屑病的年轻患者，其骨痛和肌肉无力症状已持续超过6.5年。他最终被诊断为肿瘤诱导的骨软化症。然而，长期将患者的体征和症状错误归因于银屑病关节炎导致患者出现多种并发症。最终，肿瘤被定位并手术切除。这使得临床症状改善且所有生化异常得以解决。
据我们所知，这是第二例伴有银屑病的肿瘤诱导的骨软化症病例。越来越多的证据表明，成纤维细胞生长因子-23在调节免疫功能中起作用，而其水平升高可能在银屑病的发病机制中起作用。因此，肿瘤诱导的骨软化症可能通过分泌大量成纤维细胞生长因子-23影响银屑病的临床病程。另一方面，多项研究表明银屑病患者发生恶性肿瘤的风险增加。因此，长期患银屑病可能使患者易患分泌成纤维细胞生长因子-23的肿瘤。最后，由于银屑病是一种常见疾病，这种表现可能仅仅是一种巧合。
