Pickering Marie-Eva, Bouvier Damien, Puravet Antoine, Soubrier Martin, Sapin Vincent, Oris Charlotte
Rheumatology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, INSERM, GReD, 63000 Clermont-Ferrand, France.
Clin Biochem. 2022 Jun;104:62-65. doi: 10.1016/j.clinbiochem.2022.03.006. Epub 2022 Mar 22.
Tumor-induced osteomalacia (TIO) is a paraneoplastic syndrome characterized by hypophosphatemia associated with elevated fibroblast growth factor 23 (FGF23). TIO is primarily caused by benign mesenchymal tumors of the soft tissue and skeleton. Rarely, it is associated with a solid tumor or hematological malignancy. To date, no case of osteomalacia related to pancreatic cancer has been reported in the literature.
A 77-year-old woman was admitted to the rheumatology department (RD) of the Clermont-Ferrand University Hospital (France) for further evaluation of her hypophosphatemia. The patient reported bone pain, myalgia, and asthenia. Further laboratory tests revealed hyperphosphaturia, normocalcemia, low serum calcitriol, elevated serum alkaline phosphatase (ALP), and elevated plasma parathyroid hormone (PTH). A renal phosphate depletion disorder was suspected as an etiology for this hypophosphatemia. Finally, FGF23 levels were found to be significantly elevated, leading to a definitive diagnosis of pancreatic neuroendocrine tumor.
This is the first report of hypophosphatemic osteomalacia related to pancreatic cancer. Therefore, in the setting of hypophosphatemia associated with renal phosphate wasting and low calcitriol level, plasma FGF23 measurement should be considered.
肿瘤诱导的骨软化症（TIO）是一种副肿瘤综合征，其特征为低磷血症伴成纤维细胞生长因子23（FGF23）升高。TIO主要由软组织和骨骼的良性间充质肿瘤引起。很少情况下，它与实体瘤或血液系统恶性肿瘤有关。迄今为止，文献中尚未报道过与胰腺癌相关的骨软化症病例。
一名77岁女性因低磷血症进一步评估入住法国克莱蒙费朗大学医院风湿科（RD）。患者自述有骨痛、肌痛和乏力。进一步的实验室检查显示高磷尿症、血钙正常、血清骨化三醇水平低、血清碱性磷酸酶（ALP）升高以及血浆甲状旁腺激素（PTH）升高。怀疑肾性磷酸盐消耗障碍是该低磷血症的病因。最终，发现FGF23水平显著升高，从而确诊为胰腺神经内分泌肿瘤。
这是首例与胰腺癌相关的低磷性骨软化症报告。因此，在伴有肾性磷酸盐消耗和低骨化三醇水平的低磷血症情况下，应考虑检测血浆FGF23水平。
