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What neurologists need to understand outside their own speciality
Tumour-induced osteomalacia: a rare cause of chronic pain and weakness
  1. John T Nasr1,
  2. Jack Tohme2,
  3. Michael T Collins3,
  4. Matthew T Drake4,
  5. Iris R Hartley3,
  6. Jad Sfeir4,
  7. Keith Dockery5,
  8. Metin Taskin6
  1. 1 Neuroscience, Valley Hospital, Ridgewood, New Jersey, USA
  2. 2 Endocrinology, Valley Hospital, Ridgewood, New Jersey, USA
  3. 3 Skeletal Diseases and Mineral Homeostasis Section of NIDCR Disorders, National Institutes of Health, Bethesda, Maryland, USA
  4. 4 Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 Diagnostic Imaging, Valley Hospital, Ridgewood, New Jersey, USA
  6. 6 Pathology, Valley Hospital, Ridgewood, New Jersey, USA
  1. Correspondence to Dr John T Nasr, Neuroscience, Valley Hospital, Ridgewood, NJ 07450, USA; jnasr{at}neurobergen.com

Abstract

Tumor-induced osteomalacia is a rare and often misdiagnosed condition that presents with progressively worsening unexplained chronic pain and proximal muscle weakness. The osteomalacia leads to multiple stress fractures which do not heal properly, leading to progressive disability. It is caused by chronic hypophosphatemia due to inappropriate urinary phosphate wasting. This is due to a typically benign mesenchymal tumor that over-secretes a phospaturic hormone. Neurologists need to appreciate the relevance of chronic hypophosphatemia in people with chronic unexplained pain, as timely diagnosis and treatment of tumour-induced osteomalacia can be curative.

  • CLINICAL NEUROLOGY
  • NEUROENDOCRINOLOGY
  • METABOLIC DISEASE
  • PAIN

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

http://dx.doi.org/10.1136/pn-2022-003394

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study.

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    Footnotes

    • Contributors JTN contributed to the planning, conduct reporting and conception and design. JT contributed to the planning, conduct, acquisition of data, analysis and interpretation of data. MTC contributed to the planning, conduct, reporting, conception and design, analysis and interpretation of data MTD contributed to the planning, conduct, reporting, conception and design, acquisition of data, analysis and interpretation of data. IH contributed to the planning, conduct, reporting, conception and design, analysis and interpretation of data. JS contributed to the reporting, conception and design, acquisition and analysis of data. KD contributed to the planning, conduct, reporting, acquisition of data, analysis and interpretation of data. MT contributed to the reporting, analysis and interpretation of data.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned. Externally peer reviewed by Richard Davenport, Edinburgh, UK and Fiona McKevitt, Sheffield, UK.

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      Practical Neurology 2022; 22 445-445 Published Online First: 30 Nov 2022. doi: 10.1136/pn-2022-003637

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