title: [Hyperparathyroidism associated with hypophosphatemic osteomalacia: case report and review of the literature].
abstract: Adult-onset hypophosphatemic osteomalacia is a rare disease characterized by hypophosphatemia, increased levels of alkaline phosphatase and decreased bone mass. Oral supplementation with phosphate and vitamin D is the main treatment and, in cases of oncogenic osteomalacia, tumor resection is mandatory. We report the case of a patient with hypophosphatemic osteomalacia of an unknown cause. Despite extensive search, no tumor was found. The patient was treated with phosphate for a long period and developed tertiary hyperparathyroidism. Serum PTH levels did not return to normal after surgical excision of three parathyroids and the patient refused to continue clinical investigation and treatment. After ten years absent from the hospital, during which medications were used irregularly, she was admitted with multiple fractures and respiratory insufficiency caused by severe thoracic deformities, and died. The authors discuss the relationship between osteomalacia and hyperparathyroidism and the aggressive course of the disease.
authors.affiliation: Serviço de Endocrinologia, Instituto Estadual de Diabetes e Endocrinologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ. rom_br@yahoo.com
authors.forename: Rodrigo O
authors.initials: RO
authors.lastname: Moreira
authors.forename: Christianne T S
authors.initials: CT
authors.lastname: Leal
authors.forename: Paulo Gustavo S
authors.initials: PG
authors.lastname: Lacativa
authors.forename: João Guilherme
authors.initials: JG
authors.lastname: Figueiredo
authors.forename: Maurício B
authors.initials: MB
authors.lastname: Lima
authors.forename: Maria Lucia F
authors.initials: ML
authors.lastname: Farias
mesh_terms: D017809:Fatal Outcome; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology*; D006801:Humans; D006961:Hyperparathyroidism / Q000139:chemically induced* / Q000601:surgery; D017674:Hypophosphatemia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D010018:Osteomalacia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016105:Parathyroidectomy; D010710:Phosphates / Q000009:adverse effects* / Q000627:therapeutic use; D012720:Severity of Illness Index; D014807:Vitamin D / Q000627:therapeutic use*
chemical_list: D010710:Phosphates; D014807:Vitamin D