A Case Report of Hypophosphatemia Leading to the Diagnosis of Mesothelioma

Our plain-English summary of A Case Report of Hypophosphatemia Leading to the Diagnosis of Mesothelioma, by Z.W. Goh, F. Hasan (Curēus, 2022).

The study

• Authors: Z.W. Goh, F. Hasan
• Journal: Curēus
• Published: 2022;14(5):e25285
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Hypophosphatemia can be commonly encountered as an electrolyte imbalance and is defined as a value less than 0.8 mmol/l (2.5 mg/dl). It can be an incidental finding, but it is not uncommon to see it presenting with varied symptoms. It is good to have a clear diagnostic approach to this so adequate treatment can be instated. We present a 66-year-old gentleman who presented with hypophosphatemia. Investigations confirmed renal phosphate wasting secondary to fibroblast growth factor-23 (FGF-23). Imaging showed right pleural effusion, and pleural biopsy confirmed malignant mesothelioma. This may just be an association rather than the cause of his hypophosphatemia. It does however highlight the importance of further investigations for patients with tumor-induced osteomalacia.

Copyright © 2022, Goh et al.

In plain English

This article was a case report about one man, aged 66, a retired office worker and never-smoker, who was referred with two years of tiredness, hand cramps and general bone aches. His blood phosphate was low on repeated testing, at 0.5 mmol/L against a reference range of 0.8 to 1.5. A 24-hour urine test showed phosphate excretion of 20.2 mmol per 24 hours, which the authors said confirmed phosphate loss in the urine. His level of the hormone fibroblast growth factor-23 (FGF-23) was 101 RU/ml (reference below 100), which they said confirmed FGF-23-mediated low phosphate. A PET scan looking for the hormone's source found a large right pleural effusion (fluid around the lung) and a left adrenal nodule, later found to be a non-functioning adenoma. A right pleural biopsy confirmed malignant mesothelioma. He had surgery and chemotherapy with cisplatin and pemetrexed within a trial, and his phosphate returned to normal without supplements. The authors concluded the mesothelioma may be coincidental rather than the cause of the low phosphate. The article did not mention asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 66-year-old man, a retired office worker and never-smoker, referred with a two-year history of lethargy, hand cramps and generalized bony aches; location and dates of care not stated
• Exposure: The article does not report any asbestos or other occupational exposure; the patient is described only as a retired office worker who never smoked
• Main results:
  • The patient's blood phosphate was 0.5 mmol/L (reference range 0.8 to 1.5), confirmed low on two further tests
  • The patient's 24-hour urine phosphate excretion was 20.2 mmol per 24 hours (reference 13.0 to 42.0), which the authors said confirmed urinary phosphate loss
  • The patient's FGF-23 was 101 RU/ml (reference below 100), which the authors said confirmed FGF-23-mediated hypophosphatemia
  • The patient's PET scan showed an incidental left adrenal nodule (later found to be a non-functioning adenoma) and a large right pleural effusion
  • A biopsy of the patient's right parietal pleura, taken by video-assisted thoracoscopic surgery, confirmed malignant mesothelioma
  • The patient had pleurectomy decortication and adjuvant cisplatin and pemetrexed chemotherapy within a trial
  • After this treatment, the patient's phosphate returned to normal without supplements
• The authors' conclusion: The authors concluded that the mesothelioma may be coincidental rather than the cause of the patient's low phosphate. They also said that investigating urinary phosphate loss helps avoid missing serious diagnoses such as tumor-induced osteomalacia.
• Limitations the authors state:
  • The authors state that the mesothelioma may be only an association, not the cause of the patient's hypophosphatemia

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Fibroblast, Pleural Effusion, Pleural Biopsy.

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