Authors describe a case of
oncogenic osteomalacia in a 35-year-old man, who presented with a 2-year history of generalized
pain and progressive weakness of lower limbs, eventually became bedbound. At admission, he had severe hip
pain resulting from bilateral
femoral neck fractures. Laboratory investigations revealed
hypophosphatemia,
hyperphosphaturia, normocalcemia, elevated
alkaline phosphatase and normal serum levels of
parathormone and
25-hydroxyvitamin D. Serum
fibroblast growth factor 23 (FGF23) level was elevated. A radiographic skeletal survey showed
osteoporosis and
insufficiency fractures of the femoral neck. A whole-body functional imaging failed to reveal any areas of increased activity. However, on computed tomography and magnetic resonance imaging of the head and neck region, a
tumor was discovered at left nasal cavity. The
tumor was surgically removed. After surgery, his symptoms were relieved and biochemical parameters normalized. We stress that careful clinical examination including nose and paranasal sinuses may be rewarding in cases with hypophosphatemic
osteomalacia.