Oncogenic osteomalacia and metastatic breast cancer: a case report and review of the literature

22Citations
Citations of this article
36Readers
Mendeley users who have this article in their library.

Abstract

Objectives: Oncogenic osteomalacia is a rare paraneoplastic metabolic syndrome that is characterised by severe hypophosphataemia, hyperphosphaturia and osteomalacia secondary to renal loss of phosphate. It is commonly caused by overproduction of fibroblast growth factor-23 (FGF23) from benign tumours of mesenchymal origin. Currently, there is no clear evidence on the management of oncogenic osteomalacia in patients with metastatic solid tumours. Methods: We report a case of breast cancer-induced oncogenic osteomalacia and discuss its diagnosis and management. Results: A 71-year-old woman with advanced breast cancer developed symptomatic oncogenic osteomalacia with raised FGF23, severe hypophosphataemia and hypocalcaemia. The electrolytic disturbances were exacerbated after the administration of bisphosphonates in the context of her oncological treatment. Systemic chemotherapy and maintenance endocrine treatment along with phosphate and calcium supplementation reduced the activity of oncogenic osteomalacia and resolved the electrolytic imbalances. Conclusions: To our knowledge, this is the first reported case of oncogenic osteomalacia in a patient with breast cancer. Oncogenic osteomalacia constitutes a diagnostic and therapeutic challenge. Pre-clinical and clinical evidence suggest that a possible underlying mechanism is the presence of molecular alterations in the FGF/FGFR signalling pathway leading to overexpression of FGF23. In metastatic setting, anticancer treatment can potentially lead to the normalisation of the electrolytic disturbances and reduction of the activity of oncogenic osteomalacia. The use of antiresorptive therapy in patients with bone metastases can potentially trigger FGF23 overexpression. Its use should be guided by the patients’ risk of skeletal-related events and electrolytic disturbances as well as the degree of activity of oncogenic osteomalacia.

References Powered by Scopus

Comprehensive molecular portraits of human breast tumours

9498Citations
N/AReaders
Get full text

FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis

1592Citations
N/AReaders
Get full text

Mechanisms of cisplatin nephrotoxicity

1355Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Tumor-Induced Osteomalacia

106Citations
N/AReaders
Get full text

Interdisciplinary management of FGF23-related phosphate wasting syndromes: a Consensus Statement on the evaluation, diagnosis and care of patients with X-linked hypophosphataemia

67Citations
N/AReaders
Get full text

Challenges in the management of tumor-induced osteomalacia (TIO)

39Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Savva, C., Adhikaree, J., Madhusudan, S., & Chokkalingam, K. (2019). Oncogenic osteomalacia and metastatic breast cancer: a case report and review of the literature. Journal of Diabetes and Metabolic Disorders, 18(1), 267–272. https://doi.org/10.1007/s40200-019-00398-y

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 12

80%

Researcher 3

20%

Readers' Discipline

Tooltip

Medicine and Dentistry 14

74%

Agricultural and Biological Sciences 3

16%

Biochemistry, Genetics and Molecular Bi... 1

5%

Nursing and Health Professions 1

5%

Save time finding and organizing research with Mendeley

Sign up for free