Severe hypophosphatemic osteomalacia secondary to fanconi syndrome due to adefovir: A case report

Andrea Palermo, Rocky Strollo, Rocco Papalia, Luca D'Onofrio, Ernesto Maddaloni, Silvia Irina Briganti, Nicola Napoli, Umberto Vespasiani, Sebastiano Costantino, Paolo Pozzilli, Vincenzo Denaro, Silvia Manfrini

Research output: Contribution to journalArticle

Abstract

Generalized proximal, type 2, renal tubular acidosis, also known as Fanconi syndrome, is a generalized dysfunction of the proximal renal tubule characterized by impaired reabsorption and increased urinary loss of phosphate and other solutes, such as uric acid, glucose, amino acids, and bicarbonate. Chronic hypophosphatemia is the second most common cause of osteomalacia after vitamin D deficiency in adult patients and can have a heterogeneous presentation, ranging from mild symptoms such as muscle weakness and skeletal pain to more severe presentation, such as disabling myopathy, severe bone and joint pain, difficulty walking, and even bone fractures.Methods: This report describes a case of severe hypophosphatemic osteomalacia with multiple fragility fractures induced by adefovir, which was worsened and confounded by a previous treatment with zoledronic acid and required prolonged intravenous potassium phosphate administration.Results: We highlight the limited diagnostic value of dual X-ray absorptiometry and bone scintigraphy in this challenging diagnosis. Bone metabolism should always be assessed in patients treated with adefovir for early detection of osteomalacia due to Fanconi syndrome.Conclusion: Although rare, this condition may be life-threatening and mimic other bone metabolic disorders that are treated with drugs that may further impair phosphate balance.

Original languageEnglish
Pages (from-to)e246-e249
JournalEndocrine Practice
Volume20
Issue number12
DOIs
Publication statusPublished - Dec 1 2014

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Fanconi Syndrome
Osteomalacia
Bone and Bones
zoledronic acid
Phosphates
Renal Tubular Acidosis
Mobility Limitation
Hypophosphatemia
Proximal Kidney Tubule
Vitamin D Deficiency
Bone Fractures
Muscle Weakness
Photon Absorptiometry
Arthralgia
Muscular Diseases
Bicarbonates
Uric Acid
Radionuclide Imaging
Amino Acids
Glucose

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Palermo, A., Strollo, R., Papalia, R., D'Onofrio, L., Maddaloni, E., Briganti, S. I., ... Manfrini, S. (2014). Severe hypophosphatemic osteomalacia secondary to fanconi syndrome due to adefovir: A case report. Endocrine Practice, 20(12), e246-e249. https://doi.org/10.4158/EP14251.CR

Severe hypophosphatemic osteomalacia secondary to fanconi syndrome due to adefovir : A case report. / Palermo, Andrea; Strollo, Rocky; Papalia, Rocco; D'Onofrio, Luca; Maddaloni, Ernesto; Briganti, Silvia Irina; Napoli, Nicola; Vespasiani, Umberto; Costantino, Sebastiano; Pozzilli, Paolo; Denaro, Vincenzo; Manfrini, Silvia.

In: Endocrine Practice, Vol. 20, No. 12, 01.12.2014, p. e246-e249.

Research output: Contribution to journalArticle

Palermo, A, Strollo, R, Papalia, R, D'Onofrio, L, Maddaloni, E, Briganti, SI, Napoli, N, Vespasiani, U, Costantino, S, Pozzilli, P, Denaro, V & Manfrini, S 2014, 'Severe hypophosphatemic osteomalacia secondary to fanconi syndrome due to adefovir: A case report', Endocrine Practice, vol. 20, no. 12, pp. e246-e249. https://doi.org/10.4158/EP14251.CR
Palermo A, Strollo R, Papalia R, D'Onofrio L, Maddaloni E, Briganti SI et al. Severe hypophosphatemic osteomalacia secondary to fanconi syndrome due to adefovir: A case report. Endocrine Practice. 2014 Dec 1;20(12):e246-e249. https://doi.org/10.4158/EP14251.CR
Palermo, Andrea ; Strollo, Rocky ; Papalia, Rocco ; D'Onofrio, Luca ; Maddaloni, Ernesto ; Briganti, Silvia Irina ; Napoli, Nicola ; Vespasiani, Umberto ; Costantino, Sebastiano ; Pozzilli, Paolo ; Denaro, Vincenzo ; Manfrini, Silvia. / Severe hypophosphatemic osteomalacia secondary to fanconi syndrome due to adefovir : A case report. In: Endocrine Practice. 2014 ; Vol. 20, No. 12. pp. e246-e249.
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