Clinical Snapshot
Whole-Body Pain in a Case of a Phosphaturic Tumor
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In January 2022, a female patient in her 80s presented to our department with a 12-month history of progressive, persistent whole body pain that was not related to movement or strain. Prior to this presentation, three other hospitals had failed to make a specific diagnosis. The extensive diagnostic work-up showed only treatment-resistant hypophosphatemia and a significantly elevated serum fibroblast growth factor (FGF)23 level (C-terminal 427, normal value 26–110 kRU/L). These laboratory findings were suggestive of a phosphaturic mesenchymal tumor, as a result of which 18F-fluorodeoxyglucose positron emission tomography (18-FDG-PET/CT) was performed, which prompted suspicion of a tumor in the left foot (Figure a). Subsequent magnetic resonance imaging confirmed this diagnosis. The patient underwent surgical R0 resection of the tumor (Figure b). Histological analysis revealed a benign phosphaturic mesenchymal tumor. No further phosphate substitution was required over the following weeks; the whole body pain resolved completely. At 2-year follow-up, the patient was entirely free of symptoms. Treatment-resistant hypophosphatemia combined with an elevated serum FGF23 level points to a phosphaturic tumor requiring surgical excision. Calcium and phosphate mobilization can induce painful osteomalacia.
Prof. Dr. med. Konstantinos Anagnostakos, Dr. med. Ismail Sahan, Zentrum für Orthopädie und Unfallchirurgie, Klinikum Saarbrücken, k.anagnostakos@web.de
Prof. Dr. med. Winfried Häuser, Klinik für Gastroenterologie, Hepatologie, Diabetologie, Endokrinologie und Infektiologie, Klinikum Saarbrücken
Conflict of interest statement: The authors state that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Anagnostakos K, Sahan I, Häuser W: Whole-body pain in a case of a phosphaturic tumor. Dtsch Arztebl Int 2024; 121: 890b. DOI: 10.3238/arztebl.m2024.0149
