肿瘤性低磷骨软化症一例报道并文献复习
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摘要
肿瘤性低磷骨软化症(TIO)是临床上一种罕见的伴瘤综合征,由肿瘤导致肾脏排磷增加,造成的获得性低血磷骨软化症。TIO起病隐匿,临床误诊率较高,但仍具有典型的临床特点,如肌无力、进行性骨痛、身高变矮等。临床中应提高对该病的认识,早期诊断,明确肿瘤位置,手术切除一般可达到较好的治疗效果。对于疑似TIO患者,仔细的体格检查,并结合实验室检查、影像学检查等手段对肿瘤的发现和定位具有重要意义。本文回顾性报道了被诊断为TIO且得到成功诊治的患者1例,并对相关文献进行了复习,以提高临床医生对本病的认识,为临床工作提供借鉴。
Tumor-induced osteomalacia(TIO) is a rare paraneoplastic syndrome in the clinic setting.TIO is caused by excessive phosphorus excretion induced by the tumor,and is thus categorized as an acquired hypophosphatemic osteomalacia.TIO has an occult onset and is associated with a high rate of misdiagnosis,although TIO has some typical clinical features,such as amyosthenia,progressive ostealgia,and loss of height.Practitioners should have increased awareness of TIO.Early diagnosis,correctly positioning of the tumor,and surgical resection can achieve good outcomes.For those patients suspected to have TIO,a thorough physical examination combined with laboratory testing and imaging are sufficient for the detection and positioning of the tumor.We report herein a patient who was diagnosed with TIO and successfully treated.The relevant literature is reviewed to improve the knowledge of the disease and provide reference for clinical work.
Tumor-induced osteomalacia(TIO) is a rare paraneoplastic syndrome in the clinic setting.TIO is caused by excessive phosphorus excretion induced by the tumor,and is thus categorized as an acquired hypophosphatemic osteomalacia.TIO has an occult onset and is associated with a high rate of misdiagnosis,although TIO has some typical clinical features,such as amyosthenia,progressive ostealgia,and loss of height.Practitioners should have increased awareness of TIO.Early diagnosis,correctly positioning of the tumor,and surgical resection can achieve good outcomes.For those patients suspected to have TIO,a thorough physical examination combined with laboratory testing and imaging are sufficient for the detection and positioning of the tumor.We report herein a patient who was diagnosed with TIO and successfully treated.The relevant literature is reviewed to improve the knowledge of the disease and provide reference for clinical work.
引文
[1]赵永强,田德增,金楠,等.低磷骨软化症11例分析[J].疑难病杂志,2014,13(1):88-89,91.DOI:10.3969/j.issn.1671-6450.2014.01.031.ZHAO Y Q,TIAN D Z,JIN N,et al.Analysis of 11-cases of hypophosphatemia osteomalacia[J].Chinese Journal of Difficult and Complicated Cases,2014,13(1):88-89,91.DOI:10.3969/j.issn.1671-6450.2014.01.031.
[2]李梅,孟迅吾,邢小平,等.胸腺类癌导致肿瘤性低磷软骨病一例[J].中华医学代谢杂志,2003,83(23):2028.DOI:10.3760/j:issn:0376-2491.2003.23.027.LI M,MENG X W,XING X P,et al.Thymic carcinomas induced osteomalacia:one case report[J].National Medical Journal of China,2003,83(23):2028.DOI:10.3760/j:issn:0376-2491.2003.23.027.
[3]CHONG W H,MOLINOLO A A,CHEN C C,et al.Tumorinduced osteomalacia[J].Endocr Relat Cancer,2011,18(3):R53-77.DOI:10.1530/ERC-11-0006.
[4]柯耀华,章振林,张惠箴,等.肿瘤性骨软化症二例并文献复习[J].中华内分泌代谢杂志,2009,25(4):465-467.DOI:10.3760/cma.j.issn.1000-6699.2009.04.036.KE Y H,ZHANG Z L,ZHANG H Z,et al.Tumor induced osteomalacia:two case reports and literature review[J].Chinese Journal of Endocrinology and Metabolism,2009,25(4):465-467.DOI:10.3760/cma.j.issn.1000-6699.2009.04.036.
[5]杜洪泉,郑燕,章振林,等.低磷性骨软化症的临诊应对[J].中华内分泌代谢杂志,2014,30(8):697-700.DOI:10.3760/cma.j.issn.1000-6699.2014.08.015.DU H Q,ZHENG Y,ZHANG Z L,et al.Approach to the patient with hypophosphatemic osteomalacia[J].Chinese Journal of Endocrinology and Metabolism,2014,30(8):697-700.DOI:10.3760/cma.j.issn.1000-6699.2014.08.015.
[6]伍汉文.佝偻病与骨软化症[J].医学临床研究,2002,19(9):263-267.DOI:10.3969/j.issn.1671-7171.2002.09.011.WU H W.Rickets and osteomalacia[J].Journal of Clinical Research,2002,19(9):263-267.DOI:10.3969/j.issn.1671-7171.2002.09.011.
[7]MINISOLA S,PEACOCK M,FUKUMOTO S,et al.Tumourinduced osteomalacia[J].Nat Rev Dis Primers,2017,3:17044.DOI:10.1038/nrdp.2017.44.
[8]QUARLES L D.FGF23,PHEX,and MEPE regulation of phosphate homeostasis and skeletal mineralization[J].Am J Physiol Endocrinol Metab,2003,285(1):e1-9.DOI:10.1152/ajpendo.00016.2003.
[9]KAHN J,LAGAKOS S,WULFSOHN M,et al.Efficacy and safety of adefovir dipivoxil with antiretroviral therapy:a randomized controlled trial[J].JAMA,1999,282(24):2305-2312.DOI:10.1001/jama.282.24.2305.
[10]DADONIENE J,MIGLINAS M,MILTINIENE D,et al.Tumourinduced osteomalacia:a literature review and a case report[J].World J Surg Oncol,2016,14(1):4.DOI:10.1186/S12957-015-0763-7.
[11]WHITE K E,JONSSON K B,CARN G,et al.The autosomal dominant hypophosphatemic rickets(ADHR)gene is a secreted polypeptide overexpressed by tumors that cause phosphate wasting[J].J Clin Endocrinol Metab,2001,86(2):497-500.DOI:10.1210/jcem.86.2.7408.
[12]姜艳,夏维波,孟迅吾,等.FGF23、MEPE和s FRP4在肿瘤性骨软化症发病机制中的作用[J].国际内分泌代谢杂志,2009,29(3):190-192,207.DOI:10.3760/cma.j.issn.1673-4157.2009.03.013.JIANG Y,XIA W B,MENG X W,et al.Roles of FGF23,MEPE and s FRP4 in the pathogenesis of tumor induced osteomalacia[J].International Journal of Endocrinology and Metabolism,2009,29(3):190-192,207.DOI:10.3760/cma.j.issn.1673-4157.2009.03.013.
[13]巴建明,桑艳红,陆菊明,等.12例肿瘤性骨软化症的临床诊治及术后随访[J].中华内分泌代谢杂志,2011,27(1):19-23.DOI:10.3760/cma.j.issn.1000-6699.2011.01.007.BA J M,SANG Y H,LU J M,et al.Clinical management and postoperative follow up of 12 patients with tumor-induced osteomalacia[J].Chinese Journal of Endocrinology and Metabolism,2011,27(1):19-23.DOI:10.3760/cma.j.issn.1000-6699.2011.01.007.
[14]JIANG Y,XIA W B,XING X P,et al.Tumor-induced osteomalacia:an important cause of adult-onset hypophos-phatemic osteomalacia in China:report of 39 cases and review of the literature[J].J Bone Mineral Res,2012,27(9):1967-1975.DOI:10.1002/jbmr.1642.
[15]ZUO Q Y,WANG H,LI W,et al.Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors:retrospective review of 12 patients[J].BMC Musculoskelet Disord,2017,18(1):403.DOI:10.1186/s12891-017-1756-1.
[16]张化冰,潘慧,李方,等.奥曲肽显像诊断肿瘤性骨软化一例[J].中华医学杂志,2005,85(33):2375-2376.DOI:10.3760/j:issn:0376-2491.2005.33.020.ZHANG H B,PAN H,LI F,et al.A case of osteomalacia was diagnosed by octreotide imaging[J].National Medical Journal of China,2005,85(33):2375-2376.DOI:10.3760/j:issn:0376-2491.2005.33.020.
[17]CLIFLON-BLIGH R J,HOFMAN M S,DUNCAN E,et al.Impmving diagnosis of tumor-induced osteomalacia with Gallium-68DOTATATE PET/CT[J].J Clin Endocdnol Metab,2013,98(2):678-694.DOI:10.1210/jc.2012-3642.
[18]CHONG W H,MOLLNOJO A A,CHEN C C,et al.Tumorinduced osteomalacia[J].Endocr Relat Cancer,2011,18(3):R53-77.DOI:10.1530/ERC-11-0006.
[19]HESSE E,ROSENTHAL H,BASTIAN L.Radiofrequency ablation of a tumor causing oncogenic osteomalacia[J].N Engl J Med,2007,357(4):422-424.DOI:10.1056/NEJMc070347.
[20]TUTTON S,0LSON E,KING D,et al.Successful treatment of tumor-induced osteomalacia with CT-guided percutaneous ethanol and cryoab-lation[J].J Clin Endocrinol Metab,2012,97(10):3421-3425.DOI:10.1210/jc.2012-1719.
[2]李梅,孟迅吾,邢小平,等.胸腺类癌导致肿瘤性低磷软骨病一例[J].中华医学代谢杂志,2003,83(23):2028.DOI:10.3760/j:issn:0376-2491.2003.23.027.LI M,MENG X W,XING X P,et al.Thymic carcinomas induced osteomalacia:one case report[J].National Medical Journal of China,2003,83(23):2028.DOI:10.3760/j:issn:0376-2491.2003.23.027.
[3]CHONG W H,MOLINOLO A A,CHEN C C,et al.Tumorinduced osteomalacia[J].Endocr Relat Cancer,2011,18(3):R53-77.DOI:10.1530/ERC-11-0006.
[4]柯耀华,章振林,张惠箴,等.肿瘤性骨软化症二例并文献复习[J].中华内分泌代谢杂志,2009,25(4):465-467.DOI:10.3760/cma.j.issn.1000-6699.2009.04.036.KE Y H,ZHANG Z L,ZHANG H Z,et al.Tumor induced osteomalacia:two case reports and literature review[J].Chinese Journal of Endocrinology and Metabolism,2009,25(4):465-467.DOI:10.3760/cma.j.issn.1000-6699.2009.04.036.
[5]杜洪泉,郑燕,章振林,等.低磷性骨软化症的临诊应对[J].中华内分泌代谢杂志,2014,30(8):697-700.DOI:10.3760/cma.j.issn.1000-6699.2014.08.015.DU H Q,ZHENG Y,ZHANG Z L,et al.Approach to the patient with hypophosphatemic osteomalacia[J].Chinese Journal of Endocrinology and Metabolism,2014,30(8):697-700.DOI:10.3760/cma.j.issn.1000-6699.2014.08.015.
[6]伍汉文.佝偻病与骨软化症[J].医学临床研究,2002,19(9):263-267.DOI:10.3969/j.issn.1671-7171.2002.09.011.WU H W.Rickets and osteomalacia[J].Journal of Clinical Research,2002,19(9):263-267.DOI:10.3969/j.issn.1671-7171.2002.09.011.
[7]MINISOLA S,PEACOCK M,FUKUMOTO S,et al.Tumourinduced osteomalacia[J].Nat Rev Dis Primers,2017,3:17044.DOI:10.1038/nrdp.2017.44.
[8]QUARLES L D.FGF23,PHEX,and MEPE regulation of phosphate homeostasis and skeletal mineralization[J].Am J Physiol Endocrinol Metab,2003,285(1):e1-9.DOI:10.1152/ajpendo.00016.2003.
[9]KAHN J,LAGAKOS S,WULFSOHN M,et al.Efficacy and safety of adefovir dipivoxil with antiretroviral therapy:a randomized controlled trial[J].JAMA,1999,282(24):2305-2312.DOI:10.1001/jama.282.24.2305.
[10]DADONIENE J,MIGLINAS M,MILTINIENE D,et al.Tumourinduced osteomalacia:a literature review and a case report[J].World J Surg Oncol,2016,14(1):4.DOI:10.1186/S12957-015-0763-7.
[11]WHITE K E,JONSSON K B,CARN G,et al.The autosomal dominant hypophosphatemic rickets(ADHR)gene is a secreted polypeptide overexpressed by tumors that cause phosphate wasting[J].J Clin Endocrinol Metab,2001,86(2):497-500.DOI:10.1210/jcem.86.2.7408.
[12]姜艳,夏维波,孟迅吾,等.FGF23、MEPE和s FRP4在肿瘤性骨软化症发病机制中的作用[J].国际内分泌代谢杂志,2009,29(3):190-192,207.DOI:10.3760/cma.j.issn.1673-4157.2009.03.013.JIANG Y,XIA W B,MENG X W,et al.Roles of FGF23,MEPE and s FRP4 in the pathogenesis of tumor induced osteomalacia[J].International Journal of Endocrinology and Metabolism,2009,29(3):190-192,207.DOI:10.3760/cma.j.issn.1673-4157.2009.03.013.
[13]巴建明,桑艳红,陆菊明,等.12例肿瘤性骨软化症的临床诊治及术后随访[J].中华内分泌代谢杂志,2011,27(1):19-23.DOI:10.3760/cma.j.issn.1000-6699.2011.01.007.BA J M,SANG Y H,LU J M,et al.Clinical management and postoperative follow up of 12 patients with tumor-induced osteomalacia[J].Chinese Journal of Endocrinology and Metabolism,2011,27(1):19-23.DOI:10.3760/cma.j.issn.1000-6699.2011.01.007.
[14]JIANG Y,XIA W B,XING X P,et al.Tumor-induced osteomalacia:an important cause of adult-onset hypophos-phatemic osteomalacia in China:report of 39 cases and review of the literature[J].J Bone Mineral Res,2012,27(9):1967-1975.DOI:10.1002/jbmr.1642.
[15]ZUO Q Y,WANG H,LI W,et al.Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors:retrospective review of 12 patients[J].BMC Musculoskelet Disord,2017,18(1):403.DOI:10.1186/s12891-017-1756-1.
[16]张化冰,潘慧,李方,等.奥曲肽显像诊断肿瘤性骨软化一例[J].中华医学杂志,2005,85(33):2375-2376.DOI:10.3760/j:issn:0376-2491.2005.33.020.ZHANG H B,PAN H,LI F,et al.A case of osteomalacia was diagnosed by octreotide imaging[J].National Medical Journal of China,2005,85(33):2375-2376.DOI:10.3760/j:issn:0376-2491.2005.33.020.
[17]CLIFLON-BLIGH R J,HOFMAN M S,DUNCAN E,et al.Impmving diagnosis of tumor-induced osteomalacia with Gallium-68DOTATATE PET/CT[J].J Clin Endocdnol Metab,2013,98(2):678-694.DOI:10.1210/jc.2012-3642.
[18]CHONG W H,MOLLNOJO A A,CHEN C C,et al.Tumorinduced osteomalacia[J].Endocr Relat Cancer,2011,18(3):R53-77.DOI:10.1530/ERC-11-0006.
[19]HESSE E,ROSENTHAL H,BASTIAN L.Radiofrequency ablation of a tumor causing oncogenic osteomalacia[J].N Engl J Med,2007,357(4):422-424.DOI:10.1056/NEJMc070347.
[20]TUTTON S,0LSON E,KING D,et al.Successful treatment of tumor-induced osteomalacia with CT-guided percutaneous ethanol and cryoab-lation[J].J Clin Endocrinol Metab,2012,97(10):3421-3425.DOI:10.1210/jc.2012-1719.