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Tumor-induced osteomalacia: experience from three tertiary care centers in India
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by recalcitrant hypophosphatemia. Reports from the Indian subcontinent are scarce, with most being single center experiences involving few patients. Herein, we conducted a retrospective analysis of 30 patients of TIO di...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Bioscientifica Ltd
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410764/ https://www.ncbi.nlm.nih.gov/pubmed/30726771 http://dx.doi.org/10.1530/EC-18-0552 |
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author | Pal, Rimesh Bhadada, Sanjay Kumar Singhare, Awesh Bhansali, Anil Kamalanathan, Sadishkumar Chadha, Manoj Chauhan, Phulrenu Sood, Ashwani Dhiman, Vandana Sharma, Dinesh Chandra Saikia, Uma Nahar Chatterjee, Debajyoti Agashe, Vikas |
author_facet | Pal, Rimesh Bhadada, Sanjay Kumar Singhare, Awesh Bhansali, Anil Kamalanathan, Sadishkumar Chadha, Manoj Chauhan, Phulrenu Sood, Ashwani Dhiman, Vandana Sharma, Dinesh Chandra Saikia, Uma Nahar Chatterjee, Debajyoti Agashe, Vikas |
author_sort | Pal, Rimesh |
collection | PubMed |
description | Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by recalcitrant hypophosphatemia. Reports from the Indian subcontinent are scarce, with most being single center experiences involving few patients. Herein, we conducted a retrospective analysis of 30 patients of TIO diagnosed at three tertiary care hospitals in India. Patients with persistent hypophosphatemia (despite correction of hypovitaminosis D), normocalcemia, elevated alkaline phosphatase, low TmP/GFR and elevated or ‘inappropriately normal’ FGF23 levels were labeled as having TIO. They were sequentially subjected to functional followed by anatomical imaging. Patients with a well-localized tumor underwent excision; others were put on phosphorous and calcitriol supplementation. The mean age at presentation was 39.6 years with female:male ratio of 3:2. Bone pain (83.3%) and proximal myopathy (70%) were the chief complaints; 40% of cases had fractures. The mean delay in diagnosis was 3.8 years. Tumors were clinically detectable in four patients (13.3%). The mean serum phosphate was 0.50 mmol/L with a median serum FGF23 level of 518 RU/mL. Somatostatin receptor-based scintigraphy was found to be superior to FDG-PET in tumor localization. Lower extremities were the most common site of the tumor (72%). Tumor size was positively correlated with serum FGF23 levels. Twenty-two patients underwent tumor resection and 16 of them had phosphaturic mesenchymal tumors. Surgical excision led to cure in 72.7% of patients whereas disease persistence and disease recurrence were seen in 18.2% and 9.1% of cases, respectively. At the last follow-up, serum phosphate in the surgically treated group was significantly higher than in the medically managed group. |
format | Online Article Text |
id | pubmed-6410764 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Bioscientifica Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-64107642019-03-14 Tumor-induced osteomalacia: experience from three tertiary care centers in India Pal, Rimesh Bhadada, Sanjay Kumar Singhare, Awesh Bhansali, Anil Kamalanathan, Sadishkumar Chadha, Manoj Chauhan, Phulrenu Sood, Ashwani Dhiman, Vandana Sharma, Dinesh Chandra Saikia, Uma Nahar Chatterjee, Debajyoti Agashe, Vikas Endocr Connect Research Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by recalcitrant hypophosphatemia. Reports from the Indian subcontinent are scarce, with most being single center experiences involving few patients. Herein, we conducted a retrospective analysis of 30 patients of TIO diagnosed at three tertiary care hospitals in India. Patients with persistent hypophosphatemia (despite correction of hypovitaminosis D), normocalcemia, elevated alkaline phosphatase, low TmP/GFR and elevated or ‘inappropriately normal’ FGF23 levels were labeled as having TIO. They were sequentially subjected to functional followed by anatomical imaging. Patients with a well-localized tumor underwent excision; others were put on phosphorous and calcitriol supplementation. The mean age at presentation was 39.6 years with female:male ratio of 3:2. Bone pain (83.3%) and proximal myopathy (70%) were the chief complaints; 40% of cases had fractures. The mean delay in diagnosis was 3.8 years. Tumors were clinically detectable in four patients (13.3%). The mean serum phosphate was 0.50 mmol/L with a median serum FGF23 level of 518 RU/mL. Somatostatin receptor-based scintigraphy was found to be superior to FDG-PET in tumor localization. Lower extremities were the most common site of the tumor (72%). Tumor size was positively correlated with serum FGF23 levels. Twenty-two patients underwent tumor resection and 16 of them had phosphaturic mesenchymal tumors. Surgical excision led to cure in 72.7% of patients whereas disease persistence and disease recurrence were seen in 18.2% and 9.1% of cases, respectively. At the last follow-up, serum phosphate in the surgically treated group was significantly higher than in the medically managed group. Bioscientifica Ltd 2019-01-28 /pmc/articles/PMC6410764/ /pubmed/30726771 http://dx.doi.org/10.1530/EC-18-0552 Text en © 2019 The authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (http://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | Research Pal, Rimesh Bhadada, Sanjay Kumar Singhare, Awesh Bhansali, Anil Kamalanathan, Sadishkumar Chadha, Manoj Chauhan, Phulrenu Sood, Ashwani Dhiman, Vandana Sharma, Dinesh Chandra Saikia, Uma Nahar Chatterjee, Debajyoti Agashe, Vikas Tumor-induced osteomalacia: experience from three tertiary care centers in India |
title | Tumor-induced osteomalacia: experience from three tertiary care centers in India |
title_full | Tumor-induced osteomalacia: experience from three tertiary care centers in India |
title_fullStr | Tumor-induced osteomalacia: experience from three tertiary care centers in India |
title_full_unstemmed | Tumor-induced osteomalacia: experience from three tertiary care centers in India |
title_short | Tumor-induced osteomalacia: experience from three tertiary care centers in India |
title_sort | tumor-induced osteomalacia: experience from three tertiary care centers in india |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410764/ https://www.ncbi.nlm.nih.gov/pubmed/30726771 http://dx.doi.org/10.1530/EC-18-0552 |
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