ECE2020 Audio ePoster Presentations Bone and Calcium (121 abstracts)
Follow-up report: A case of FGF23-related tumor-induced osteomalacia with pulmonary adenocarcinoma
Hiroshi Arai 1 , Yugo Kanai 2 , Yuji Nakamoto 3 , Yuichi Sakamori 4 , Ichiro Yamauchi 2 , Toshihito Fujii 2 , Daisuke Taura 2 , Masakatsu Sone 2 , Akihiro Yasoda 2 & Nobuya Inagaki 2
1Kyoto Institute of Technology, Health Administration Center, Kyoto, Japan; 2Kyoto University Graduate School of Medicine, Department of Diabetes, Endocrinology and Nutrition, Kyoto, Japan; 3Kyoto University Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan; 4Kyoto University Graduate School of Medicine, Department of Respiratory Medicine, Kyoto, Japan
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by the abnormal production of fibroblast growth factor 23 (FGF23) in the tumor. We havereported a case of TIO with pulmonary adenocarcinoma at ECE2018. Here we present the follow-up report of the case. A 61-year old woman suffering from severe polyarthralgia and bilateral limb weakness was referred to our hospital. Her blood chemistry revealed high alkaline phosphatase, low phosphate, low calcium, and low 1,25-(OH)2D3. Bone-scintigraphy revealed multiple accumulations, suggesting small fractures and systemic arthritis. Endocrinological analyses exhibited elevated iPTH and markedly high FGF23 level of 3900 (reference: 14.7–40.5) pg/ml. These findings suggest that the FGF23-producing tumor induced osteomalacia. DOTATOC-PET/CT showed a major uptake in a nodular lesion of the left lung and several minor uptakes in the supraclavicular, hilar and mediastinal lymph nodes. An ultrasound-guided fine needle aspiration biopsy of the left supraclavicular lymph node revealed metastatic adenocarcinoma with a mutation in Exon19 of the EGFR gene. She was diagnosed as stage IV A (cT1cN3M1b) pulmonary adenocarcinoma, and the chemotherapy with afatinib maleate (EGFR tyrosine kinase inhibitor) was started. Simultaneously, alfacalcidol and menatetrenone were prescribed for osteomalacia. Five months later, the primary tumor and metastatic lesions gradually shrinked. The bone metabolism was almost normalized, the bone mineral density measured by DXA was improved, and FGF23 level was markedly decreased to 42 pg/ml. The arthralgia was ameliorated and controlled with minimal dose of analgesics. After the partial remission for 16 months, the metastatic lesion progressively enlarged and FGF23 was slightly elevated to 66 pg/ml. The anticancer agent was switched to osimertinib mesilate. Three months later, the lesion contracted again and FGF23 level was decreased to 34.7 pg/ml. At present, 35 months after the first visit, she is still in partial remission and working as a housewife. This is a rare case of TIO associated with pulmonary adenocarcinoma.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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