48329850003079750001417534161290Pontifical and RoyalUNIVERSITY OF SANTO TOMASTHE CATHOLIC UNIVERSITY OF THE PHILIPPINESFaculty of Pharmacy 00Pontifical and RoyalUNIVERSITY OF SANTO TOMASTHE CATHOLIC UNIVERSITY OF THE PHILIPPINESFaculty of Pharmacy Adriano, Hannah Kathlyn P. 1R-MT1st Shift Journal in MT 632″Is there any link between tumor-induced osteomalacia and psoriasis? A case report”Mojtaba Akbari1, Bagher Larijani2, Sasan Sharghi3, Ali Jalili2 and Sayed Mahmoud Sajjadi-Jazi2*Journal of Diabetes & Metabolic Disorders (2017) 16:34 DOI 10.1186/s40200-017-0315-5Tumor-induced osteomalacia (TIO) is a rare and fascinating paraneoplastic syndrome in which patients experience bone pain, fractures, and muscle weakness. The cause is high blood levels of the recently identified phosphate and vitamin D-regulating hormone, fibroblast growth factor 23 (FGF23).
Fibroblast growth factor-23 is a bone-derived phosphaturic hormone that acts on the kidney to increase phosphate excretion and vitamin D metabolism. Psoriasis is a common, genetic, and inflammatory diseases that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin which form scales and red patches that are itchy and even painful. The case report was the second case of tumor-induced osteomalacia accompanied by psoriasis. The goal of the study was to further discover the link between the mentioned diseases through extensive research and reports. Moreover, the study intends to identify and discuss the role of Fibroblast growth factor-23 in regulating immune function and in the pathogenesis of psoriasis.
The study involved a young patient who suffered from bone pain and muscle weakness for more than 6.5 years. However, the signs and symptoms were mistakenly associated with psoriatic arthritis which caused multiple complications for the patient. Later on, it was discovered that he has a tumor-induced osteomalacia. Since the patient was 10 years old, he has been receiving topical treatments for plaque-type psoriasis. Several years after, he began to experience muscle weakness, bone pain, and generalized psoriatic skin lesions. Various tests including magnetic resonance imaging (MRI) were conducted and it showed generalized skeletal demineralization. In addition, his laboratory tests revealed hypophosphatemia, high ALP, and phosphaturia.
Due to the results, a systemic therapy was initiated. He was advised to alter the dosage of his medication to further analyze its effect on his skin and bone. However, his symptoms got worsened despite the given treatment. He could barely walk and eventually became bedridden. Furthermore, there has been a significant 20-cm loss in his height, a decrease in both upper and lower limbs muscle force and skin hyperpigmentation. Radiography studies showed osteomalacia, looser zones, and multiple fractures.
Multiple results also showed changes in his joints without any evidence of inflammatory arthritis. It also showed a large amount of phosphate excretion despite low amount of serum phosphate level. Finally, the physicians have discovered that the patient have a FGF-23-related hypophosphatemia particularly TIO.
The tumor was then localize and was completely resected which led to the remineralization of the bone. His phosphate supplementation was discontinued and in his follow up check-ups it showed that muscle weakness and bone pain gradually improved. It took time to diagnose him with TIO because the nature itself of the syndrome has a very non-specific signs and symptoms that could lead to misdiagnosis. A recent published article by Okan et al. demonstrated that the FGF-23 level is high in psoriasis patients and is associated with psoriasis severity. Besides the important role of FGF-23 in phosphate homeostasis, a raised FGF-23 concentration has the capacity to induce inflammation and has a role in inhibiting keratinocytes. Overall, it was found out that TIO may alter the clinical course of psoriasis by secreting a high amount of FGF-23 causing an increased risk of malignancy among patients.
In conclusion, since psoriasis is a common disease, its link between TIO needs further research studies and investigations to prove if it is actually true or just a mere coincidence. References:Chong, W. H., Molinolo, A. A., Chen, C. C., & Collins, M.
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