Dear All,
A 65 year old man was referred to us by his GP. A former avaition
draughstman, he had been diagnosed IBS 10 years ago and now presented with
pain in his pelvis. X-ray showed Looser Zones in both femurs and the
radiographer suggested investigation of vitamin D status.
The day he was due to come to the laboratory, he was admitted to an
orthopaedic ward with a fractured right femur.
Biochemically he was NAD except for a phosphaturia (TMPO4/GFR = 1.79),
hypophosphataemia and creatinine clearance = 72ml/ml. Haematologically NAD.
By biochemically NAD, I mean:
PTH, PTH-RP, Mg, Cd (Aluminium awaited) Serum electrophoresis, urine
electrophoresis, Igs, anti endomyceal antibodies, urine calcium excretion,
25OHD, 1,25OHD, ALP, TSH, PSA - all within expected ranges, as were his
"routine" investigations.
His family history is that he has 5 siblings - ALL have carcinoma of one
form or another.
Vitamin D resistance remains a plausible answer but we would like to exclude
oncogenic oseomalacia if possible, given the f/h.
Is there a lab in the UK running the assay for FGF-23 who would be willing
to accept a sample from our gentleman?
Gareth.
Gareth Davies
Senior Clinical Biochemist
Wrexham Maelor Hospital
Wrexham LL13 7TD
UK
01978 725345
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