The University of Southampton
University of Southampton Institutional Repository

Oncogenic osteomalacia and metastatic breast cancer: a case report and review of the literature

Oncogenic osteomalacia and metastatic breast cancer: a case report and review of the literature
Oncogenic osteomalacia and metastatic breast cancer: a case report and review of the literature
Objectives
Oncogenic osteomalacia is a rare paraneoplastic metabolic syndrome that is characterised by severe hypophosphataemia, hyperphosphaturia and osteomalacia secondary to renal loss of phosphate. It is commonly caused by overproduction of fibroblast growth factor-23 (FGF23) from benign tumours of mesenchymal origin. Currently, there is no clear evidence on the management of oncogenic osteomalacia in patients with metastatic solid tumours.

Methods
We report a case of breast cancer-induced oncogenic osteomalacia and discuss its diagnosis and management.

Results
A 71-year-old woman with advanced breast cancer developed symptomatic oncogenic osteomalacia with raised FGF23, severe hypophosphataemia and hypocalcaemia. The electrolytic disturbances were exacerbated after the administration of bisphosphonates in the context of her oncological treatment. Systemic chemotherapy and maintenance endocrine treatment along with phosphate and calcium supplementation reduced the activity of oncogenic osteomalacia and resolved the electrolytic imbalances.

Conclusions
To our knowledge, this is the first reported case of oncogenic osteomalacia in a patient with breast cancer. Oncogenic osteomalacia constitutes a diagnostic and therapeutic challenge. Pre-clinical and clinical evidence suggest that a possible underlying mechanism is the presence of molecular alterations in the FGF/FGFR signalling pathway leading to overexpression of FGF23. In metastatic setting, anticancer treatment can potentially lead to the normalisation of the electrolytic disturbances and reduction of the activity of oncogenic osteomalacia. The use of antiresorptive therapy in patients with bone metastases can potentially trigger FGF23 overexpression. Its use should be guided by the patients’ risk of skeletal-related events and electrolytic disturbances as well as the degree of activity of oncogenic osteomalacia.
Savva, Constantinos
d6e87674-1443-41f4-84ba-81c1ccfeb3d7
Adhikaree, Jason
3ae88a12-337d-4953-94ba-2dea7a6706bd
Madhusudan, Srinivasan
b09d6e47-8c8f-484f-83cf-e77c2de21952
Chokkalingam, Kamal
28133a24-72e2-42c0-b1ac-2ad6d05e48d8
Savva, Constantinos
d6e87674-1443-41f4-84ba-81c1ccfeb3d7
Adhikaree, Jason
3ae88a12-337d-4953-94ba-2dea7a6706bd
Madhusudan, Srinivasan
b09d6e47-8c8f-484f-83cf-e77c2de21952
Chokkalingam, Kamal
28133a24-72e2-42c0-b1ac-2ad6d05e48d8

Savva, Constantinos, Adhikaree, Jason, Madhusudan, Srinivasan and Chokkalingam, Kamal (2019) Oncogenic osteomalacia and metastatic breast cancer: a case report and review of the literature. Journal of Diabetes & Metabolic Disorders, 18 (398), [398]. (doi:10.1007/s40200-019-00398-y).

Record type: Article

Abstract

Objectives
Oncogenic osteomalacia is a rare paraneoplastic metabolic syndrome that is characterised by severe hypophosphataemia, hyperphosphaturia and osteomalacia secondary to renal loss of phosphate. It is commonly caused by overproduction of fibroblast growth factor-23 (FGF23) from benign tumours of mesenchymal origin. Currently, there is no clear evidence on the management of oncogenic osteomalacia in patients with metastatic solid tumours.

Methods
We report a case of breast cancer-induced oncogenic osteomalacia and discuss its diagnosis and management.

Results
A 71-year-old woman with advanced breast cancer developed symptomatic oncogenic osteomalacia with raised FGF23, severe hypophosphataemia and hypocalcaemia. The electrolytic disturbances were exacerbated after the administration of bisphosphonates in the context of her oncological treatment. Systemic chemotherapy and maintenance endocrine treatment along with phosphate and calcium supplementation reduced the activity of oncogenic osteomalacia and resolved the electrolytic imbalances.

Conclusions
To our knowledge, this is the first reported case of oncogenic osteomalacia in a patient with breast cancer. Oncogenic osteomalacia constitutes a diagnostic and therapeutic challenge. Pre-clinical and clinical evidence suggest that a possible underlying mechanism is the presence of molecular alterations in the FGF/FGFR signalling pathway leading to overexpression of FGF23. In metastatic setting, anticancer treatment can potentially lead to the normalisation of the electrolytic disturbances and reduction of the activity of oncogenic osteomalacia. The use of antiresorptive therapy in patients with bone metastases can potentially trigger FGF23 overexpression. Its use should be guided by the patients’ risk of skeletal-related events and electrolytic disturbances as well as the degree of activity of oncogenic osteomalacia.

Text
s40200-019-00398-y - Version of Record
Available under License Creative Commons Attribution.
Download (236kB)

More information

Accepted/In Press date: 14 March 2019
e-pub ahead of print date: 22 March 2019

Identifiers

Local EPrints ID: 429695
URI: http://eprints.soton.ac.uk/id/eprint/429695
PURE UUID: 4b2e3ddd-dcfb-4ed6-a197-097336c375a2
ORCID for Constantinos Savva: ORCID iD orcid.org/0000-0003-0805-4719

Catalogue record

Date deposited: 03 Apr 2019 16:30
Last modified: 01 Aug 2019 00:22

Export record

Altmetrics

Contributors

Author: Jason Adhikaree
Author: Srinivasan Madhusudan
Author: Kamal Chokkalingam

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×