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FGF23-secreting sinonasal tumour presenting with acute subdural haemorrhage and tumour-induced osteomalacia.
- Source :
-
BMJ case reports [BMJ Case Rep] 2024 Aug 08; Vol. 17 (8). Date of Electronic Publication: 2024 Aug 08. - Publication Year :
- 2024
-
Abstract
- 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 <superscript>68</superscript> 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.<br />Competing Interests: Competing interests: None declared.<br /> (© BMJ Publishing Group Limited 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Humans
Female
Middle Aged
Paranasal Sinus Neoplasms complications
Paranasal Sinus Neoplasms surgery
Paraneoplastic Syndromes
Neoplasms, Connective Tissue surgery
Neoplasms, Connective Tissue diagnosis
Ethmoid Sinus surgery
Magnetic Resonance Imaging
Fibroblast Growth Factor-23
Osteomalacia etiology
Fibroblast Growth Factors blood
Fibroblast Growth Factors metabolism
Hematoma, Subdural, Acute etiology
Hematoma, Subdural, Acute surgery
Hematoma, Subdural, Acute diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1757-790X
- Volume :
- 17
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- BMJ case reports
- Publication Type :
- Academic Journal
- Accession number :
- 39122377
- Full Text :
- https://doi.org/10.1136/bcr-2023-259439