The Game Is Afoot

This clinical case study presents a 63 year old woman with a history of atraumatic fractures and bilateral ankle pain, ultimately diagnosed with tumor induced osteomalacia (TIO) caused by a phosphaturic mesenchymal tumor secreting fibroblast growth factor 23 (FGF-23). The patient’s hypophosphatemia, elevated alkaline phosphatase, and low calcitriol levels pointed to renal phosphate wasting. Localization of the tumor via ${}^{68}$Ga-Dotatate PET-CT and subsequent surgical excision led to normalization of FGF 23 and phosphate levels, with resolution of symptoms. The case highlights the importance of evaluating phosphate metabolism in unexplained fractures and the role of targeted imaging and surgery in managing TIO.

This clinical case study presents a 63 year old woman with a history of atraumatic fractures and bilateral ankle pain, ultimately diagnosed with tumor induced osteomalacia (TIO) caused by a phosphaturic mesenchymal tumor secreting fibroblast growth factor 23 (FGF-23). The patient’s hypophosphatemia, elevated alkaline phosphatase, and low calcitriol levels pointed to renal phosphate wasting. Localization of the tumor via ${}^{68}$Ga-Dotatate PET-CT and subsequent surgical excision led to normalization of FGF 23 and phosphate levels, with resolution of symptoms. The case highlights the importance of evaluating phosphate metabolism in unexplained fractures and the role of targeted imaging and surgery in managing TIO.