title: Perioperative concerns in patients with tumor-induced osteomalacia for surgical excision of tumor.
abstract: Tumor-induced osteomalacia (TIO) or oncogenic osteomalacia is a paraneoplastic syndrome, usually associated with mesenchymal tumors. TIO is probably an underreported entity owing to diagnostic and localizing limitations. With improvement in such modalities, patients with TIO are likely to be encountered more frequently in future anesthetic practice. It does not respond to conservative medical management; thus surgical resection of the lesion is the treatment of choice. Anesthetic management of such cases has not been reported in published studies and thus we report two such cases of hypophosphatemia, induced by frontoethmoidal tumors and the anesthetic implications and challenges of such a rare entity. Surgical excision of the causative lesion results in dramatic resolution of symptoms. Vigilant adherence to the pertinent perioperative concerns related to severe hypophosphatemia is crucial to a favorable surgical outcome in these patients.
authors: Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, NewDelhi, India.
authors: Ravindra
authors: R
authors: Pandey
authors: Anil
authors: A
authors: Agarwal
authors: Vanlal
authors: V
authors: Darlong
authors: Rakesh
authors: R
authors: Garg
authors: Jyotsna
authors: J
authors: Punj
mesh_terms: D003657:Decision Making; D003937:Diagnosis, Differential; D005005:Ethmoid Sinus / Q000601:surgery*; D005626:Frontal Sinus / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009372:Neoplasms, Connective Tissue / Q000175:diagnosis / Q000601:surgery*; D010018:Osteomalacia; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis / Q000601:surgery*; D010257:Paraneoplastic Syndromes; D019990:Perioperative Care / Q000379:methods*; D014057:Tomography, X-Ray Computed
references: Am J Surg Pathol. 2004 Jan;28(1):1-30
references: 14707860
references: J Clin Endocrinol Metab. 2004 Aug;89(8):3979-82
references: 15292336
references: Medicine (Baltimore). 2000 Jan;79(1):1-8
references: 10670405
references: Int J Oral Maxillofac Surg. 2007 Oct;36(10):956-8
references: 17498926
references: Anaesthesia. 1998 Sep;53(9):895-902
references: 9849285
references: Anaesthesia. 2008 Aug;63(8):873-5
references: 18547296
references: N Engl J Med. 2003 Apr 24;348(17):1656-63
references: 12711740
references: JAMA. 2005 Sep 14;294(10):1260-7
references: 16160135
references: Nat Clin Pract Nephrol. 2006 Mar;2(3):136-48
references: 16932412
references: Laryngoscope. 2006 Oct;116(10):1930-3
references: 17003734
references: Am J Med. 2005 Oct;118(10):1094-101
references: 16194637