Clinical impact of somatostatin receptor scintigraphy in the management of tumor-induced osteomalacia

Clin Nucl Med. 2008 Nov;33(11):752-6. doi: 10.1097/RLU.0b013e31818866bf.

Abstract

Objective: Tumor-induced osteomalacia (TIO) is a rare condition due to phosphate wasting secondary to the release of a phosphatonin, fibroblast growth factor-23. Attempts to identify the tumor by physical examination and/or conventional imaging are sometimes unrewarding. In such cases, somatostatin receptor scintigraphy with octreotide has been successfully proposed.

Methods: Two case reports and a review of the literature allow to demonstrate the diagnostic usefulness of octreotide and the therapeutic value of somatostatin.

Results: Octreotide studies were positive in 79% of 24 reported TIO, including our 2 cases. In one of our patients with incomplete removal of the tumor, octreotide therapy was unable to improve hypophosphatemia, despite a decrease in fibroblast growth factor-23 levels by 30%. Similar results were achieved in most of the reported cases. Surgical procedures were effective in these cases and resulted in complete clinical and biochemical recovery.

Conclusion: We highlight the impact of somatostatin receptor evaluation in the management of TIO.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Neoplasms / complications
  • Abdominal Neoplasms / diagnostic imaging*
  • Abdominal Neoplasms / drug therapy*
  • Abdominal Neoplasms / surgery
  • Adult
  • Angiolipoma / complications
  • Angiolipoma / diagnostic imaging
  • Angiolipoma / drug therapy
  • Angiolipoma / surgery
  • Bone Neoplasms / complications
  • Bone Neoplasms / diagnostic imaging*
  • Bone Neoplasms / drug therapy*
  • Bone Neoplasms / surgery
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / drug effects
  • Fibroblast Growth Factors / metabolism
  • Foot / diagnostic imaging
  • Foot / pathology
  • Hip / diagnostic imaging
  • Hip / pathology
  • Humans
  • Hypophosphatemia / drug therapy
  • Hypophosphatemia / etiology
  • Knee / diagnostic imaging
  • Knee / pathology
  • Male
  • Middle Aged
  • Octreotide / therapeutic use*
  • Osteomalacia / diagnostic imaging*
  • Osteomalacia / etiology
  • Paraneoplastic Syndromes / complications
  • Paraneoplastic Syndromes / diagnostic imaging
  • Pelvis / diagnostic imaging
  • Pelvis / pathology
  • Phosphates / metabolism
  • Phosphates / therapeutic use
  • Radionuclide Imaging / methods
  • Receptors, Somatostatin / agonists*
  • Receptors, Somatostatin / antagonists & inhibitors*
  • Ribs / diagnostic imaging
  • Ribs / pathology
  • Soft Tissue Neoplasms / complications
  • Soft Tissue Neoplasms / diagnostic imaging*
  • Soft Tissue Neoplasms / drug therapy*
  • Soft Tissue Neoplasms / surgery
  • Somatostatin / analogs & derivatives
  • Somatostatin / pharmacokinetics
  • Somatostatin / therapeutic use
  • Whole Body Imaging

Substances

  • Phosphates
  • Receptors, Somatostatin
  • Somatostatin
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23
  • pentetreotide
  • Octreotide