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BMJ Case Rep. 2010; 2010: bcr0220102750.
Published online Oct 8, 2010. doi:  10.1136/bcr.02.2010.2750
PMCID: PMC3028388
Rare disease
Imaging of tumour-induced osteomalacia using a gallium-68 labelled somatostatin analogue
Erwin Woff,1 Camilo Garcia,1 Laure Tant,2 Kristoff Muylle,1 Ghanem Ghanem,3 Pierre Bourgeois,1 and Patrick Flamen1
1Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
2Department of Rheumatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
3Department of Radiopharmacy, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
Correspondence to Camilo Garcia, camilo.garcia/at/bordet.be
Abstract
A 51-year-old man presented with generalised bone pain. Initial evaluation revealed a low serum phosphorus level and elevated urinary phosphorus excretion. Aminoaciduria was normal. Standard imaging showed only minimal changes. The patient was treated with daily oral supplementation with phosphate (1 g/day) and 1,25-dihydroxyvitamin D3 (1 μg/day) to maintain euphosphataemia. In spite of the fact that this treatment was maintained for 3 years, there was no modification of renal phosphate clearance. A diagnosis of hypophosphataemic osteomalacia with renal phosphate wasting was proposed. Therefore, tumour-induced osteomalacia was suspected, triggering a diagnostic workup to find the primary tumour. These tumours are known to express somatostatin receptors, so whole body positron emission tomography (CT) imaging was performed after intravenous administration of 68Ga-DOTA-TOC (68Ga-DOTA-D-Phe1-Tyr3-pentreotide). A solitary intense hot spot was detected in soft tissue near the right femoral internal condyle. Based on this result, curative resection of the tumour was performed.
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