Tumor-induced osteomalacia: the importance of early diagnosis

Resumo

Tumor-induced osteomalacia is a rare paraneoplasic syndrome that can be completely cured with the removal of the culprit tumor. This study described the clinical history of a patient affected by tumor-induced osteomalacia. The patient was a 57-year-old female who sought hospital due to intense and progressive pain in the lower limbs and muscle weakness, as well diffuse osteoporosis and a variety of pathologic fractures at radiographs. Laboratory tests revealed hypophosphatemia with hyperphosphaturia and raised the hypothesis of tumor-induced osteomalacia. Whole-body technetium-99m octreotide scintigraphy revealed the presence of a focal area of radiotracer uptake in the medial region of the left tarsus. After tumor excision, there was a rapid correction of serum phosphorus, reduction of musculoskeletal complaints and evidence of bone healing. Despite the diagnosis and treatment, the patient had an unfavorable clinical outcome; she developed sepsis from pulmonary focus, evolving into refractory septic shock and death. We stress the need for greater recognition of tumor-induced osteomalacia as a cause of clinical bone pain, fractures, osteopenia and muscle weakness, superimposed on the characteristic biochemical profile with hypophosphatemia and relative hyperphosphaturia. Greater awareness of the disease will allow earlier diagnosis and ultimately a greater curative potential for patients afflicted with this syndrome.