%0 Journal Article
%T FGF23 Producing Mesenchymal Tumor
%A Lucyna Papierska
%A Jarosˋaw B. ˋwikˋa
%A Waldemar Misiorowski
%A Michaˋ Rabijewski
%A Krzysztof Sikora
%A Hubert Wanyura
%J Case Reports in Endocrinology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/492789
%X A 40-year-old patient was referred to Clinic of Endocrinology due to hypophosphatemia causing pain, cramps, and weakness of muscles. Moreover, his bone mineral density was very low. The previous treatment with phosphorus and active vitamin D metabolites was ineffective. In lab tests the hypophosphatemia, hyperphosphaturia, and elevated FGF23 levels were found. Somatostatin receptor scintigraphy (SRS) showed increased radiotracer uptake in the right maxillary sinus and CT scans confirmed presence of tumor in this localization. Biopsy and cytological examination created suspicion of mesenchymal tumor〞glomangiopericytoma. Waiting for surgery the patient was treated with long acting Somatostatine analogue, and directly before operation short acting Octreotide and intravenous phosphorus were used. Histology confirmed the cytological diagnosis and the phosphatemia return to normal values in 10 days after the tumor removal. 1. Case Report A 40-year-old man was referred to Clinic of Endocrinology due to prolonged, deep hypophosphatemia causing pain, cramps, and weakness of proximal muscles. One year before, during the previous hospitalization (in neurological ward) primary muscle disease had been excluded and diagnosis of osteomalacia had been established. Diagnosis was made on basis of symptoms, low calcium and phosphorus level (2.1ˋmmol/L and 0.6ˋmmol/L, resp.), and very low 24ˋh calcium urine excretion (80ˋmg/24ˋh). PTH was then surprisingly normal that is, 57ˋpg/mL (normal ranges 15每65ˋpg/mL), and 25OHD3 level was undetectable (<4ˋng/mL). There were no fractures in patient＊s medical history; however bone mineral density was very low (in all localizations -scores and -scores <ˋ3). Patient was treated for more than one year with calcitriol 1ˋ米g, alfacalcidol 1ˋ米g, calcium 1000ˋmg, and phosphorus 1500ˋmg per day. This medication had no effect on serum concentrations of phosphorus and only a moderate effect on clinical symptoms. Patient was under dental treatment (caries and periodontitis). At admission the levels of CPK, calcium, and PTH were normal; 25OHD3 level raised to 29.1ˋng/dL (normal ranges 30每80ˋng/dL) despite using only little amount of D3 contained in Ca/D3 preparations apart from active metabolites. Alkaline phosphatase (AP) was slightly elevated (137ˋU/L; normal ranges 40每129ˋU/L) and serum phosphorus concentration was very low (0.41ˋmmol/L; normal ranges 0.81每1.45ˋmmol/L). 24ˋh urine collection showed high phosphorus excretion (66.5ˋmmol/24ˋh, normal ranges 12.00每65.00ˋmmol/24ˋh). Bone mineral density was still very low: lumbar spine -score =
%U http://www.hindawi.com/journals/crie/2014/492789/