Hypophosphatemic Osteomalacia Associated with Nonendocrine Tumors

Abstract

Two adult men with severe adult-onset hypophosphatemic osteomalacia made spectacular recoveries after removal of small benign sclerosing hemangiomas. In both cases removal of the tumor was followed by an increase in the serum inorganic phosphate to high-normal levels, relief of clinical symptoms and roentgenographic evidence of healing of the osteomalacia. In the second case, removal of the tumor increased serum immunoreactive parathyroid hormone. Some cases of adult-onset hypophosphatemic osteomalacia apparently are directly related to the presence of nonendocrine tumors that elaborate a humoral substance (other than parathyroid hormone) that markedly increases the renal clearance of phosphate, resulting in hypophosphatemia and failure of skeletal mineralization.