Marked hypophosphatemia with decreased serum 1,25-dihydroxyvitamin D in a patient with hepatocellular carcinoma complicating liver cirrhosis.
A 61-year-old male with hepatocellular carcinoma (HCC) complicating liver cirrhosis presented hypophosphatemia progressing with HCC expansion and serum alpha-fetoprotein elevation. These changes were associated with an increased fractional excretion of phosphate and decreased theoretical phosphate threshold. There was increased nephrogenous cyclic adenosine monophosphate despite normal serum parathyroid hormone. Serum 1,25-dihydroxyvitamin D levels were markedly reduced with normal 25-hydroxyvitamin D levels. There were no symptoms of osteomalacia, however, a slightly increased osteoid seam was elicited on autopsy. The hypophosphatemia could be explained by presumed secretion from HCC of humoral factors which have a phosphaturic effect and also inhibit 25-hydroxyvitamin D-1 alpha-hydroxylase in renal tubular cells.
Mizuno
Y
Y
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Masaki
N
N
Hashimoto
H
H
Ogata
I
I
Aizawa
C
C
Fujiwara
K
K
Toda
G
G
Mori
M
M
Machinami
R
R
Kurokawa
K
K
D014408:Biomarkers, Tumor / Q000097:blood; D002117:Calcitriol / Q000097:blood / Q000172:deficiency*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000150:complications / Q000378:metabolism; D053493:Cholestanetriol 26-Monooxygenase; D000242:Cyclic AMP / Q000097:blood; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007684:Kidney Tubules / Q000201:enzymology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000097:blood* / Q000150:complications / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000209:etiology*; D010710:Phosphates / Q000097:blood*; D013250:Steroid Hydroxylases / Q000037:antagonists & inhibitors; D000509:alpha-Fetoproteins / Q000032:analysis
D014408:Biomarkers, Tumor; D010710:Phosphates; D000509:alpha-Fetoproteins; D000242:Cyclic AMP; D013250:Steroid Hydroxylases; C506831:CYP27A1 protein, human; D053493:Cholestanetriol 26-Monooxygenase; D002117:Calcitriol