Tumor-Induced Osteomalacia in a Patient with Crohn’s Disease: A Case Report and Approach to Investigating Hypophosphatemia
Introduction: Hypophosphatemia occurs commonly in inflammatory bowel disease (IBD) patients and can cause considerable morbidity. The differential diagnoses in IBD include nutritional causes and hypophosphatemia induced by some formulations of intravenous iron infusions. Case Presentation: We presen...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2024-02-01
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| Series: | Case Reports in Gastroenterology |
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| Online Access: | https://beta.karger.com/Article/FullText/536136 |
| _version_ | 1827312276632240128 |
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| author | Kate Hawke Anthony Croft Syndia Lazarus |
| author_facet | Kate Hawke Anthony Croft Syndia Lazarus |
| author_sort | Kate Hawke |
| collection | DOAJ |
| description | Introduction: Hypophosphatemia occurs commonly in inflammatory bowel disease (IBD) patients and can cause considerable morbidity. The differential diagnoses in IBD include nutritional causes and hypophosphatemia induced by some formulations of intravenous iron infusions. Case Presentation: We present the case of a 37-year-old man with active Crohn’s disease, presenting with difficulty walking and fractures of the vertebrae and calcaneus. He had long-standing hypophosphatemia. Nutritional causes for hypophosphatemia were considered in the first instance given the presence of chronic diarrhea and vitamin D deficiency; however, there was minimal response to appropriate supplementation with oral phosphorous and vitamin D. Iron infusion-induced hypophosphatemia was then considered, but the nadir phosphate level preceded any iron infusion. Therefore, work-up was undertaken for less common causes. He was ultimately diagnosed with tumor-induced osteomalacia, caused by excess fibroblast growth factor 23 (FGF23) secretion from a phosphaturic mesenchymal tumor about the knee. He had complete resolution of symptoms and biochemical abnormalities following successful resection of the tumor. Conclusion: This case illustrates the approach to investigation of hypophosphatemia in IBD patients. If the time course and response to phosphate supplementation are not as expected for nutritional or iron infusion-induced hypophosphatemia, less common causes should be considered. |
| first_indexed | 2024-03-07T19:39:24Z |
| format | Article |
| id | doaj.art-51cd73910f4843538482d69e92695e99 |
| institution | Directory Open Access Journal |
| issn | 1662-0631 |
| language | English |
| last_indexed | 2024-04-24T21:39:19Z |
| publishDate | 2024-02-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Gastroenterology |
| spelling | doaj.art-51cd73910f4843538482d69e92695e992024-03-21T08:27:29ZengKarger PublishersCase Reports in Gastroenterology1662-06312024-02-01181818910.1159/000536136536136Tumor-Induced Osteomalacia in a Patient with Crohn’s Disease: A Case Report and Approach to Investigating HypophosphatemiaKate Hawke0Anthony Croft1Syndia Lazarus2Department of Diabetes and Endocrinology, Royal Brisbane and Women’s Hospital, Herston, QLD, AustraliaFaculty of Medicine, University of Queensland, Brisbane, QLD, AustraliaDepartment of Diabetes and Endocrinology, Royal Brisbane and Women’s Hospital, Herston, QLD, AustraliaIntroduction: Hypophosphatemia occurs commonly in inflammatory bowel disease (IBD) patients and can cause considerable morbidity. The differential diagnoses in IBD include nutritional causes and hypophosphatemia induced by some formulations of intravenous iron infusions. Case Presentation: We present the case of a 37-year-old man with active Crohn’s disease, presenting with difficulty walking and fractures of the vertebrae and calcaneus. He had long-standing hypophosphatemia. Nutritional causes for hypophosphatemia were considered in the first instance given the presence of chronic diarrhea and vitamin D deficiency; however, there was minimal response to appropriate supplementation with oral phosphorous and vitamin D. Iron infusion-induced hypophosphatemia was then considered, but the nadir phosphate level preceded any iron infusion. Therefore, work-up was undertaken for less common causes. He was ultimately diagnosed with tumor-induced osteomalacia, caused by excess fibroblast growth factor 23 (FGF23) secretion from a phosphaturic mesenchymal tumor about the knee. He had complete resolution of symptoms and biochemical abnormalities following successful resection of the tumor. Conclusion: This case illustrates the approach to investigation of hypophosphatemia in IBD patients. If the time course and response to phosphate supplementation are not as expected for nutritional or iron infusion-induced hypophosphatemia, less common causes should be considered.https://beta.karger.com/Article/FullText/536136hypophosphatemiainflammatory bowel diseasescrohn’s diseasemetabolic bone diseasescase report |
| spellingShingle | Kate Hawke Anthony Croft Syndia Lazarus Tumor-Induced Osteomalacia in a Patient with Crohn’s Disease: A Case Report and Approach to Investigating Hypophosphatemia Case Reports in Gastroenterology hypophosphatemia inflammatory bowel diseases crohn’s disease metabolic bone diseases case report |
| title | Tumor-Induced Osteomalacia in a Patient with Crohn’s Disease: A Case Report and Approach to Investigating Hypophosphatemia |
| title_full | Tumor-Induced Osteomalacia in a Patient with Crohn’s Disease: A Case Report and Approach to Investigating Hypophosphatemia |
| title_fullStr | Tumor-Induced Osteomalacia in a Patient with Crohn’s Disease: A Case Report and Approach to Investigating Hypophosphatemia |
| title_full_unstemmed | Tumor-Induced Osteomalacia in a Patient with Crohn’s Disease: A Case Report and Approach to Investigating Hypophosphatemia |
| title_short | Tumor-Induced Osteomalacia in a Patient with Crohn’s Disease: A Case Report and Approach to Investigating Hypophosphatemia |
| title_sort | tumor induced osteomalacia in a patient with crohn s disease a case report and approach to investigating hypophosphatemia |
| topic | hypophosphatemia inflammatory bowel diseases crohn’s disease metabolic bone diseases case report |
| url | https://beta.karger.com/Article/FullText/536136 |
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