FGF23-secreting sinonasal tumour presenting with acute subdural haemorrhage and tumour-induced osteomalacia.

Autor: Bhatia SS; Anaesthetics Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK sehajdev@hotmail.com., Malhotra PS; Neurosurgery Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Poole K; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Malaviya A; Rheumatology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Jazyk: angličtina
Zdroj: BMJ case reports [BMJ Case Rep] 2024 Aug 08; Vol. 17 (8). Date of Electronic Publication: 2024 Aug 08.
DOI: 10.1136/bcr-2023-259439
Abstrakt: A female in her 50s developed a headache, collapsed and was noted to have an acute atraumatic subdural haemorrhage (SDH) requiring surgical evacuation and intracranial pressure-directed therapy. Her background included recurrent epistaxis, severe generalised bone pain and multiple insufficiency fractures and an undifferentiated autoimmune connective tissue disease. Chronic hypophosphataemia, elevated alkaline phosphatase and raised fibroblast growth factor 23 (FGF23) were also noted. An MRI head and subsequent 68 Ga CT/positron emission tomography scan demonstrated an intensely avid tumour in the right ethmoid sinus, extending intracranially. Phosphate was aggressively replaced, and alfacalcidol was initiated to circumvent the effects of FGF23 on her kidneys and bone minerals. The tumour was biopsied and then definitively resected via combined endonasal and craniotomy approaches, resulting in good clinical improvement. FGF23 titre and serum phosphate both normalised leaving the diagnosis of a phosphaturic mesenchymal tumour-secreting FGF23, leading to tumour-induced osteomalacia.
Competing Interests: Competing interests: None declared.
(© BMJ Publishing Group Limited 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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