title: Oncogenic osteomalacia should be considered in hypophosphatemia, bone pain and pathological fractures.
abstract: The clinical manifestation of oncogenic osteomalacia includes bone pain, pathological fractures, general fatigue and muscle weakness. Such  unspecific symptoms hinder the establishment of a proper diagnosis which very often requires long-lasting investigations with many  diagnostic imaging methods. Here, we discuss difficulties in the diagnosis of oncogenic osteomalacia using the example of our own clinical  case: a 56 year-old woman with a history of pain in the left hip and two years of walking difficulties. A plain radiograph and CT scan  revealed pathological fractures. Multiple myeloma, primary hyperparathyroidism and bone metastatic disease were excluded. Routine  laboratory tests showed elevated alkaline phosphatase and a mild degree of hypophosphatemia. CT and MR imaging confirmed the  presence of a pathological mass in the thorax. Tumour excision and histopathological test results revealed the diagnosis of a phosphaturic  mesenchymal tumour. Our case, showing the clinical course of the disease from the symptoms manifested at the beginning to the  establishment of the diagnosis, can serve as a model illustration of the diagnostic struggle involved with oncogenic osteomalacia.
authors: Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland. sonia.kaniuka@amg.gda.pl
authors: Sonia
authors: S
authors: Kaniuka-Jakubowska
authors: Wojciech
authors: W
authors: Biernat
authors: Anna
authors: A
authors: Lewczuk
authors: Renata
authors: R
authors: Świątkowska-Stodulska
authors: Krzysztof
authors: K
authors: Sworczak
mesh_terms: D000469:Alkaline Phosphatase / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D005598:Fractures, Spontaneous / Q000150:complications*; D006801:Humans; D017674:Hypophosphatemia / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008637:Mesenchymoma / Q000175:diagnosis*; D008875:Middle Aged; D009372:Neoplasms, Connective Tissue / Q000175:diagnosis*; D010018:Osteomalacia; D010146:Pain; D010257:Paraneoplastic Syndromes; D014057:Tomography, X-Ray Computed
chemical_list: D000469:Alkaline Phosphatase