title: Tumour-associated osteomalacia and hypoglycaemia in a patient with prostate cancer: is Klotho involved?
abstract: Tumour-associated osteomalacia is a paraneoplastic syndrome caused by renal phosphate wasting, leading to severe hypophosphataemia. Excess of circulating fibroblast growth factor 23 (FGF23) is the likely cause, acting via the FGF23/α-Klotho coreceptor, a critical regulator of phosphate metabolism. The other possible effects of that complex in humans are still under investigation. We present a case of an 84-year-old Belgian man, presenting prostate cancer with bone metastases. From June 2010 to March 2013, he presented three episodes of disease progression. From January 2012, the patient developed a progressively marked dorsal kyphosis with significant hypophosphataemia. The calculated TRP (tubular reabsorption of phosphate) was decreased and the FGF23 increased. Mid-March 2013, the patient died after a profound unconsciousness due to hypoglycaemia with hypothermia. We hypothesised that the two paraneoplastic manifestations of this patient (tumour-associated osteomalacia and refractory hypoglycaemia) were due to one cause chain with two main nodes-FGF23 and its coreceptor Klotho..
authors.affiliation: Institut Jules Bordet, Brussels, Belgium Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Sofiya Bedo
authors.initials: SB
authors.lastname: Latifyan
authors.affiliation: Université Libre de Bruxelles, Brussels, Belgium Centre Hospitalo-Universitaire de Charleroi, Charleroi, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Vanhaeverbeek
authors.affiliation: Institut Jules Bordet, Brussels, Belgium Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Klastersky
mesh_terms: D000369:Aged, 80 and over; D000375:Aging; D014408:Biomarkers, Tumor / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D017809:Fatal Outcome; D000089703:Fibroblast Growth Factor-23; D005966:Glucuronidase / Q000097:blood*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D017674:Hypophosphatemia / Q000097:blood / Q000150:complications; D000090265:Klotho Proteins; D008297:Male; D010018:Osteomalacia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D010257:Paraneoplastic Syndromes; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications*
chemical_list: D014408:Biomarkers, Tumor; D001786:Blood Glucose; C000717427:FGF23 protein, human; D000089703:Fibroblast Growth Factor-23; D005966:Glucuronidase; D000090265:Klotho Proteins