ACTA ENDOCRINOLOGICA (BUC)

Context. Postmenopausal women are at risk of developing primary hyperparathyroidism (PHPT) and the underlying\r\ndisturbance in calcium homeostasis is suspected to have been established for some time prior to diagnosis.\r\nObjectives. Pre-menopausal women with disturbance in calcium homeostasis suggesting PHPT have been evaluated during\r\nmenopausal transition regarding associated morbidity.\r\nDesign and subjects. Premenopausal women, 40 to 50 years of age, were screened with parameters of calcium homeostasis in\r\nconjunction with routine mammography during 2002-2003. Those who fulfilled preset criteria of mild PHPT (cases) (n=173) were matched to controls (n=193). The pre/perimenopausal\r\nwomen were investigated for the prevalence of PHPT in association with skeletal changes, morbidity and impact on\r\nquality of life (base-line data already published). They have now been re-evaluated regarding different health aspects after three years follow-up.\r\nResults. The cases still had lower bone mineral density (BMD) in total hip, femoral neck and distal third of radius than controls (p<0.05) after three years followup. Time of follow-up, menopausal status, and weight affected BMD independently.\r\nConclusion. Middle-aged women with mild disturbances of calcium homeostasis suggesting early PHPT, had lower BMD in the hip and radius, but the decline in BMD was not accelerated during menopausal transition.

Background. Oncogenic osteomalacia (OOM) is a rare syndrome caused by a tumor that produces a phosphaturic factor: fibroblast growth factor 23 (FGF23). These tumors can be extremely difficult to localize because they are small, slow growing and cause no local symptoms.\r\nPatient and methods: Venous sampling for detection of a gradient of FGF23 has been used to limit the area of further\r\nimaging. We describe a case of OOM in a 73-year old woman, with two years of spontaneous fractures, severe musculoskeletal pain and phosphate wasting.\r\nResults: Her serum FGF23 level was increased and whole-body intravenous sampling (11 sites) revealed a FGF23 gradient\r\nfrom the right leg. The second sampling indicated that the source of FGF23 was below the knee, but imaging studies, including magnetic resonance imaging and octreotide scintigraphy, were not conclusive. A third sampling demonstrated increasing FGF23 the more distal one came in the lower leg. Imaging of the forefoot finally identified a 10 mm tumor that was removed. Histopathological examination showed a phosphaturic mesenchymal tumor of mixed connective\r\ntissue type. The phosphate level and symptoms improved in days after surgery.\r\nConclusion: Repeated determinations of a venous gradient of FGF23 may be used to localize tumors of OOM.