YO34 - A rare endocrinological syndrome presenting with weakness in Soft tissue sarcoma - a Case report

Case summary

Background

Alteration in Urinary phosphate levels has been considered to be a paraneoplastic syndrome. This case report sheds light on a rare endocrinological cause of limb weakness.

Case details

A 31 year old female, a known case of pleomorphic leiomyosarcoma post surgery, post adjuvant chemotherapy with recently diagnosed parenchymal and pleural deposits presented with weakness in legs since the past 3 days, abnormal movements involving both the arms since the past 1 day and altered sensorium since the past 2 days. There was no history of symptoms of raised intracranial tension or metastatic spinal cord compression. Examination revealed reduced power in both the upper and lower limbs with downgoing flexors. Further investigation revealed reduced levels of serum phosphate, serum calcium and transaminiitis. Based upon recent reports available with the patient, vitamin D levels were found to be low whereas Intact PTH was found to be normal. A diagnosis of tumor induced osteomalacia versus Pazopanib induced fanconi’s syndrome was considered. She was started on oral phosphate supplements and vitamin D.

Conclusion

Tumor induced osteomalacia needs to be recognized as a reversible causes of quadriparesis in the advanced cancer population with mesenchymal tumours. The diagnosis was made in the Palliative medicine ward in the absence of 24 hour urinary phosphate levels or serum FGF levels.

Clinical trial identification

Editorial acknowledgement