title: Coexistence of tumor-induced osteomalacia and primary hyperparathyroidism.
abstract: OBJECTIVE
  To present an unusual case of coexisting tumor-induced osteomalacia (TIO) and primary hyperparathyroidism (PHPT).
  
  
  METHODS
  We report the clinical features, imaging studies, and the results of laboratory investigations before and after surgical resection of both a soft-tissue tumor and a parathyroid adenoma.
  
  
  RESULTS
  A 44-year-old woman was referred to the endocrinology department with a diagnosis of PHPT accompanied by unusually severe hypophosphatemia, despite having received treatment with cinacalcet. Debilitating muscle weakness and bone pain, severe phosphaturia and hypophosphatemia, inappropriately normal calcitriol, and elevated fibroblast growth factor-23 and intact parathyroid hormone levels raised the suspicion of coexisting TIO and PHPT. Imaging studies were negative, but histologic characteristics of a palpable subcutaneous mass from the patient's thigh revealed a phosphaturic mesenchymal tumor. Complete remission after surgical removal of both the soft-tissue tumor and the parathyroid adenoma confirmed the diagnosis.
  
  
  CONCLUSIONS
  The coexistence of TIO and PHPT has not been described before and can cause life-threatening hypophosphatemia. Diagnosis and localization of the tumor is of paramount importance since surgery is the treatment of choice for both TIO and PHPT.
authors.affiliation: Department of Endocrinology and Diabetes Center, G. Gennimatas Hospital, Athens, Greece. amarkouuk@yahoo.co.uk
authors.forename: Athina
authors.initials: A
authors.lastname: Markou
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Tsiama
authors.forename: Symeon
authors.initials: S
authors.lastname: Tournis
authors.forename: Labrini
authors.initials: L
authors.lastname: Papanastasiou
authors.forename: Vaios
authors.initials: V
authors.lastname: Tsiavos
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Dassou
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Vlachou
authors.forename: Eugenia
authors.initials: E
authors.lastname: Papaliodi
authors.forename: Niki
authors.initials: N
authors.lastname: Asimaki
authors.forename: George
authors.initials: G
authors.lastname: Zografos
authors.forename: George
authors.initials: G
authors.lastname: Piaditis
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D000328:Adult; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology; D006044:Goiter, Nodular / Q000209:etiology; D006801:Humans; D006811:Humerus / Q000473:pathology / Q000601:surgery; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000601:surgery; D017674:Hypophosphatemia / Q000209:etiology; D018908:Muscle Weakness / Q000209:etiology; D009372:Neoplasms, Connective Tissue / Q000150:complications* / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D010018:Osteomalacia; D010257:Paraneoplastic Syndromes; D010280:Parathyroid Glands / Q000473:pathology / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D013848:Thigh / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D016896:Treatment Outcome