Dramatic mitigation of bone pain after phosphorus replacement therapy in a subject with FGF23-related hypophosphatemic osteomalaciaReportar como inadecuado




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SpringerPlus

, 5:1904

Medicine

Abstract

IntroductionFibroblast growth factor 23 FGF23 is secreted from bone and suppresses the absorption of phosphorus in renal proximal tubule and in intestinal tract. Therefore, the increase of serum FGF23 levels leads to hypophosphatemic situations. Tumor-induced osteomalacia is often induced by various tumors, but it is often difficult to identify the localization of tumor, because most of the FGF23-producing tumors are small and could be observed in any part of the body.

Case descriptionHere we report a case of elderly female subject with FGF23-related hypophosphatemic osteomalacia who repeatedly experienced severe bone pain and fragility fracture in various parts of the body. Although we failed to identify the localization of tumor in this subject even with various examination, after starting phosphorus replacement therapy with relatively small amounts of calcium phosphate 1.5 g-day phosphorus content: 270 mg, hypophosphatemia was ameliorated and repeated bone pain was dramatically mitigated without any surgical operation.

Discussion and EvaluationEven when we fail to identify the localization of tumor in subjects with FGF23-related hypophosphatemic osteomalacia, phosphorus replacement therapy for hypophosphatemia could reduce the bone pain.

ConclusionsWe should be aware of the possibility that phosphorus replacement therapy exert marked beneficial effects for the reduction of bone pain in subjects with FGF23-related hypophosphatemic osteomalacia even when we fail to identify tumor localization.

KeywordsFGF23 Phosphorus Hypophosphatemic osteomalacia Bone pain Fragility fracture Phosphorus replacement AbbreviationsWBCwhite blood cell

Neuneutrophil

Lymphlymphocyte

Monomonocyte

Eoseosinophil

Basobasophil

Monomonocyte

RBCred blood cell

Hbhemoglobin

Hthematocrit

pltplatelet

TPtotal protein

Albalbumin

T-biltotal bilirubin

ASTaspartate transaminase

ALTalanine transaminase

ɣ-GTPgamma-glutamyl transferase

ALPalkaline phosphatase

LDHlactate dehydrogenase

ChEcholinesterase

Crecreatinine

BUNblood urea nitrogen

UAuric acid

CKcreatine kinase

CRPC-reactive protein

PBSplasma blood glucose

HbA1chemoglobin A1c

LDL chollow density lipoprotein cholesterol

HDL cholhigh density lipoprotein cholesterol

TGtriglyceride

TSHthyroid-stimulating hormone

FT4free thyroxine

IgGimmunoglobulin G

IgAimmunoglobulin A

IgMimmunoglobulin M

Nasodium

Kpotassium

Clchloride

IPphosphorus

Cacalcium

EFCafractional excretion of calcium

PTHparathyroid hormone

PTHrPparathyroid hormone-related protein-C

1,25OH2D31-25-dihydroxyvitamin D3

25OHD25-hydrovitamin D

ACTHadrenocorticotropic hormone

DHEA-Sdehydroepiandrosterone sulfate

FGF23fibroblast growth factor 23

NTxtype I collagen cross-linked N-telopeptide

TRACP-5btartrate-resistant acid phosphatase-5b

BAPbone-type alkaline phosphatase

ucOCundercarboxylated osteocalcin

PINPtype I procollagen N-terminal propeptide

CEAcarcinoembryonic antigen

CA19-9carbohydrate antigen 19–9

CA125cancer antigen 125

SLXsialyl lewis x antigen

AFPalpha-fetoprotein

SCCsquamous cell carcinoma

CYFRAcytokeratin fragment

ProGRPpro gastrin-releasing peptide

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Autor: Fuminori Tatsumi - Megumi Horiya - Akihito Tanabe - Momoyo Nishioka - Yoshiro Fushimi - Junpei Sanada - Yurie Hirata - Shin

Fuente: https://link.springer.com/







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