Cancarevic Ivan, Ilyas Usman, Nassar Mahmoud
Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA.
Internal Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, New York, USA.
Cureus. 2023 Jun 15;15(6):e40487. doi: 10.7759/cureus.40487. eCollection 2023 Jun.
Hypophosphatemia is among the most common electrolyte abnormalities, especially among patients with underlying malignancies, and is frequently associated with adverse prognoses. Phosphorus levels are regulated through a number of mechanisms, including parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), vitamin D, and other electrolyte levels themselves. Clinically, the findings are nonspecific, and the diagnosis is frequently delayed. This article is a narrative literature review. The PubMed database was searched for relevant articles pertaining to hypophosphatemia causes and consequences in patients suffering from multiple myeloma. We found a variety of causes of hypophosphatemia in patients with multiple myeloma. Tumor-induced osteopenia, although more common among patients with small squamous cell carcinomas, can occur with multiple myeloma as well. Additionally, both light chains themselves and medications can trigger Fanconi syndrome, which leads to phosphorus wasting by the kidney. Bisphosphonates, in addition to being a possible cause of Fanconi syndrome, lead to a decrease in calcium levels, which then stimulates parathyroid hormone (PTH) release, predisposing the patient to significant hypophosphatemia. Additionally, many of the more modern medications used to manage multiple myeloma have been associated with hypophosphatemia. A better understanding of those mechanisms may give clinicians a clearer idea of which patients may need more frequent screening as well as what the potential triggers in the individual patient may be.
低磷血症是最常见的电解质异常之一，尤其是在患有潜在恶性肿瘤的患者中，并且经常与不良预后相关。磷水平通过多种机制进行调节，包括甲状旁腺激素（PTH）、成纤维细胞生长因子-23（FGF-23）、维生素D以及其他电解质水平本身。临床上，这些表现是非特异性的，诊断常常延迟。本文是一篇叙述性文献综述。我们在PubMed数据库中搜索了与多发性骨髓瘤患者低磷血症的病因和后果相关的文章。我们发现多发性骨髓瘤患者低磷血症有多种病因。肿瘤诱导的骨质减少虽然在小鳞状细胞癌患者中更常见，但在多发性骨髓瘤患者中也可能发生。此外，轻链本身和药物都可引发范科尼综合征，导致肾脏排磷。双膦酸盐除了可能是范科尼综合征的病因外，还会导致钙水平降低，进而刺激甲状旁腺激素（PTH）释放，使患者易发生严重低磷血症。此外，许多用于治疗多发性骨髓瘤的现代药物都与低磷血症有关。更好地了解这些机制可能会让临床医生更清楚哪些患者可能需要更频繁的筛查，以及个体患者潜在的触发因素可能是什么。
