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Tumor-Induced Osteomalacia

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Abstract

Tumor-induced osteomalacia is an acquired paraneoplastic disease of the bone that occurs due to oversecretion of the phosphaturic hormone FGF23 by a functioning tumor. Clinical features are similar to other causes of osteomalacia such as bone pains, bone deformities, and bone weakness. The underlying causative tumor is usually asymptomatic. Laboratory hallmarks are hypophosphatemia, phosphaturia, and low 1,25 dihydroxy vitamin D. The causative tumor must be located by a combination of physical examination and functional and anatomical imaging tests. Cure is possible and prognosis is favorable when the causative tumor is completely excised. When surgery is not possible or carries significant postoperative morbidity, a variety of pharmacologic agents and tumor-directed therapies can be employed.

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Abbreviations

CT:

Computed tomography

DOTANOC:

1,4,7,10-Tetraazacyclododecane -D-Phe1-1-Nal3-octreotide

DOTATATE:

1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid octreotate

DOTATOC:

1,4,7,10-Tetraazacyclododecane-N,N,N,N-tetraacetic-acid-D-Phe1 -Tyr3 –octreotide

FDG:

Fluorodeoxyglucose

FGF:

Fibroblast growth factor

HYNIC-TOC:

Hydrazinonicotinyl-Tyr3-Octreotide

MEPE:

Matrix extracellular phosphoglycoprotein

MIBI:

Methoxyisobutylisonitrile

MRI:

Magnetic resonance imaging

NPT:

Sodium-phosphate cotransporter

OOM:

Oncogenic osteomalacia

PET:

Positron emission tomography

PMT:

Phosphaturic mesenchymal tumor

PMTMCT:

Phosphaturic mesenchymal tumor, mixed connective tissue variant

sFRP-4:

Secreted frizzled-related protein 4

SPECT:

Single photon emission computed tomography

TIO:

Tumor-induced osteomalacia

TmP/GFR:

Tubular maximum reabsorption of phosphate corrected for glomerular filtration rate

TRP:

Tubular phosphate reabsorption

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  1. Department of Physiology and Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

    Mark Anthony Sandoval

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Correspondence to Mark Anthony Sandoval .

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  1. Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL, USA

    Pauline M. Camacho

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Sandoval, M.A. (2019). Tumor-Induced Osteomalacia. In: Camacho, P. (eds) Metabolic Bone Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-03694-2_11

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  • DOI: https://doi.org/10.1007/978-3-030-03694-2_11

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