title: Tumor-induced osteomalacia: an important cause of adult-onset hypophosphatemic osteomalacia in China: Report of 39 cases and review of the literature.
abstract: Tumor-induced osteomalacia (TIO) is an acquired form of hypophosphatemia. Tumor resection leads to cure. We investigated the clinical characteristics of TIO, diagnostic methods, and course after tumor resection in Beijing, China, and compared them with 269 previous published reports of TIO. A total of 94 patients with adult-onset hypophosphatemic osteomalacia were seen over a 6-year period (January, 2004 to May, 2010) in Peking Union Medical College Hospital. After physical examination (PE), all patients underwent technetium-99m octreotide scintigraphy ((99) Tc(m) -OCT). Tumors were removed after localization. The results demonstrated that 46 of 94 hypophosphatemic osteomalacia patients had high uptake in (99) Tc(m) -OCT imaging. Forty of them underwent tumor resection with the TIO diagnosis established in 37 patients. In 2 patients, the tumor was discovered on PE but not by (99) Tc(m) -OCT. The gender distribution was equal (M/F = 19/20). Average age was 42 ± 14 years. In 35 patients (90%), the serum phosphorus concentration returned to normal in 5.5 ± 3.0 days after tumor resection. Most of the tumors (85%) were classified as phosphaturic mesenchymal tumor (PMT) or mixed connective tissue variant (PMTMCT). Recurrence of disease was suggested in 3 patients (9%). When combined with the 269 cases reported in the literature, the mean age and sex distribution were similar. The tumors were of bone (40%) and soft tissue (55%) origins, with 42% of the tumors being found in the lower extremities. In summary, TIO is an important cause of adult-onset hypophosphatemia in China. (99) Tc(m) -OCT imaging successfully localized the tumor in the overwhelming majority of patients. Successful removal of tumors leads to cure in most cases, but recurrence should be sought by long-term follow-up.
authors.affiliation: Department of Endocrinology, Key Laboratory of Chinese Health Ministry, Peking Union Medical College Hospital, Academy of Medical Science, Shuaifuyuan 1, Dong Cheng, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Jiang
authors.forename: Wei-bo
authors.initials: WB
authors.lastname: Xia
authors.forename: Xiao-ping
authors.initials: XP
authors.lastname: Xing
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Silva
authors.forename: Mei
authors.initials: M
authors.lastname: Li
authors.forename: Ou
authors.initials: O
authors.lastname: Wang
authors.forename: Hua-bing
authors.initials: HB
authors.lastname: Zhang
authors.forename: Fang
authors.initials: F
authors.lastname: Li
authors.forename: Hong-li
authors.initials: HL
authors.lastname: Jing
authors.forename: Ding-romg
authors.initials: DR
authors.lastname: Zhong
authors.forename: Jin
authors.initials: J
authors.lastname: Jin
authors.forename: Peng
authors.initials: P
authors.lastname: Gao
authors.forename: Lian
authors.initials: L
authors.lastname: Zhou
authors.forename: Fang
authors.initials: F
authors.lastname: Qi
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.forename: John P
authors.initials: JP
authors.lastname: Bilezikian
authors.forename: Xun-wu
authors.initials: XW
authors.lastname: Meng
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D017674:Hypophosphatemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009372:Neoplasms, Connective Tissue / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000601:surgery; D010018:Osteomalacia; D010257:Paraneoplastic Syndromes; D010758:Phosphorus / Q000097:blood; D055815:Young Adult
chemical_list: D010758:Phosphorus; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23