title: Deliberate total parathyroidectomy: a potentially novel therapy for tumor-induced hypophosphatemic osteomalacia.
abstract: BACKGROUND
  Tumor-induced osteomalacia (TIO) is an acquired hypophosphatemic metabolic bone disorder that can be cured by removing or ablating the offending tumor. However, when the tumor cannot be localized, lifelong therapy with oral phosphate and calcitriol or cinacalcet with close monitoring is required.
  
  
  METHODS
  A 56-year-old man was diagnosed with TIO in 1990. Initial therapy consisted of oral phosphate and calcitriol with symptomatic and biochemical improvement and healing of osteomalacia. Eight years later, hypercalcemic hyperparathyroidism developed, requiring subtotal parathyroidectomy with a transient increase in serum phosphate and normalization of serum calcium and PTH. Recurrent hypercalcemic hyperparathyroidism developed after 10 years of medical therapy. A deliberate total parathyroidectomy produced a prompt rise in serum phosphate into the normal range > 3.0 mg/dL and remained normal during the next 4 years of follow-up, despite continued very high serum fibroblast growth factor-23 levels throughout the 23-year follow-up.
  
  
  CONCLUSIONS
  We report an unusual case of a TIO patient with long-term follow-up who developed recurrent hypercalcemic hyperparathyroidism on long-term oral phosphate therapy. Deliberate total parathyroidectomy normalized serum phosphate despite persistently elevated fibroblast growth factor-23 levels. Total parathyroidectomy offers a potentially novel therapy in some patients with TIO in whom medical therapy is not feasible or the tumor is unresectable.
authors: Bone and Mineral Research Laboratory, Henry Ford Hospital, 3031 West Grand Boulevard, Suite 800, Detroit, Michigan 48202-3141. srao1@hfhs.org.
authors: Sanjay K
authors: SK
authors: Bhadada
authors: Saroj
authors: S
authors: Palnitkar
authors: Shijing
authors: S
authors: Qiu
authors: Nayana
authors: N
authors: Parikh
authors: Gary B
authors: GB
authors: Talpos
authors: Sudhaker D
authors: SD
authors: Rao
mesh_terms: D001859:Bone Neoplasms / Q000150:complications*; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000601:surgery*; D017674:Hypophosphatemia / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010018:Osteomalacia / Q000209:etiology / Q000601:surgery*; D010280:Parathyroid Glands / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D016896:Treatment Outcome