Adriano, Hannah Kathlyn P.
1st 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/s40200-017-0315-5
Tumor-induced osteomalacia (TIO) is a rare 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 works increase phosphate excretion and helps metabolize vitamin D.
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 study involved a young patient who suffered from bone pain and muscle weakness for more than 6.5 years. However, due to its complex signs and symptoms he was misdiagnose with psoriatic arthritis which caused him multiple complications. Later on, it was discovered that he has a tumor-induced osteomalacia.
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 as well as its connection to the pathogenesis of psoriasis.
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 skeletal demineralization. In addition, his laboratory tests revealed hypophosphatemia (extremely low phosphate level), high Alkaline Phosphatase (ALP), and phosphaturia (urine excretion of excessive amounts of phosphate). Due to the results, 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. Multiple results also showed changes in his joints without any evidence of inflammatory arthritis. 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 d can inhibit 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. T. (2011, June). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433741/Fibroblast growth factor 23. (n.d.). Retrieved from https://www.sciencedirect.com/topics/neuroscience/fibroblast-growth-factor-23Liu, S. (2007, June 01). Shiguang Liu. Retrieved from http://jasn.asnjournals.org/content/18/6/1637.fullM., B., S., A., & S. (2017, August 23). Is there any link between tumor-induced osteomalacia and psoriasis? A case report. Retrieved from https://jdmdonline.biomedcentral.com/articles/10.1186/s40200-017-0315-5
Okan G, Baki AM, Yorulmaz E, Dog?ru-Abbasog?lu S, Vural P. Fibroblast growth factor 23 and placental growth factor in patients with psoriasis and their relation to disease severity. Ann Clini Lab Sci. 2016;46(2):174–9.
Psoriasis. (2018, March 06). Retrieved from https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840Tumor-induced osteomalacia tio: Topics by Science.gov. (n.d.). Retrieved from https://www.science.gov/topicpages/t/tumor-induced osteomalacia tio.html