Improving diagnosis of tumor-induced osteomalacia with Gallium-68 DOTATATE PET/CT

Clifton-Bligh, Roderick J., Hofman, Michael S., Duncan, Emma, Sim, Ie-Wen, Darnell, David, Clarkson, Adele, Wong, Tricia, Walsh, John P., Gill, Anthony J., Ebeling, Peter R. and Hicks, Rodney J. (2013) Improving diagnosis of tumor-induced osteomalacia with Gallium-68 DOTATATE PET/CT. Journal of Clinical Endocrinology and Metabolism, 98 2: 687-694. doi:10.1210/jc.2012-3642

Author Clifton-Bligh, Roderick J.
Hofman, Michael S.
Duncan, Emma
Sim, Ie-Wen
Darnell, David
Clarkson, Adele
Wong, Tricia
Walsh, John P.
Gill, Anthony J.
Ebeling, Peter R.
Hicks, Rodney J.
Title Improving diagnosis of tumor-induced osteomalacia with Gallium-68 DOTATATE PET/CT
Journal name Journal of Clinical Endocrinology and Metabolism   Check publisher's open access policy
ISSN 0021-972X
Publication date 2013-02-01
Year available 2013
Sub-type Article (original research)
DOI 10.1210/jc.2012-3642
Volume 98
Issue 2
Start page 687
End page 694
Total pages 8
Place of publication Chevy Chase, MD, U.S.A.
Publisher The Endocrine Society Press
Collection year 2014
Language eng
Formatted abstract
Context: Tumor-induced osteomalacia (TIO) is a rarely diagnosed disorder presenting with bone pain, fractures, muscle weakness, and moderate-to-severe hypophosphatemia resulting from fibroblast growth factor 23-mediated renal phosphate wasting. Tumors secreting fibroblast growth factor 23 are often small and difficult to find with conventional imaging.

Objective: We studied the utility of 68Ga-DOTA-octreotate (DOTATATE) somatostatin receptor positron emission tomography (PET)/computed tomography (CT) imaging in the diagnosis of TIO.

Design and Setting: A multicenter case series was conducted at tertiary referral hospitals.

Patients and Methods
: Six patients with TIO diagnosed between 2003 and 2012 in Australia were referred for DOTATATE PET imaging. We reviewed the clinical history, biochemistry, imaging characteristics, histopathology, and clinical outcome of each patient.

Results: Each case demonstrated delayed diagnosis despite severe symptoms. DOTATATE PET/CT imaging demonstrated high uptake and localized the tumor with confidence in each case. After surgical excision, there was resolution of clinical symptoms and serum phosphate, except in one patient who demonstrated residual disease on PET/CT. All tumors demonstrated high somatostatin receptor subtype 2 cell surface receptor expression using immunohistochemistry.

Conclusions: In patients with TIO, DOTATATE PET/CT can successfully localize phosphaturic mesenchymal tumors and may be a practical first step in functional imaging for this disorder. Serum phosphate should be measured routinely in patients with unexplained muscle weakness, bone pain, or stress fractures to allow earlier diagnosis of TIO.

Keyword Of-the-literature
Oncogenic osteomalacia
Mesenchymal tumors
Hypophosphatemic osteomalacia
Octreotide therapy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2014 Collection
UQ Diamantina Institute Publications
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Citation counts: TR Web of Science Citation Count  Cited 16 times in Thomson Reuters Web of Science Article | Citations
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