Prevalence of FGF23 elevation in patients with hypophosphatemia.

BACKGROUND AND AIMS: To investigate the contribution of FGF23 in explaining the cases of hypophosphatemia observed in clinical practice, we aimed to determine for the first time the prevalence of FGF23 elevation in patients with hypophosphatemia and to describe the different mechanisms of FGF23-related hypophosphatemic disorders. MATERIALS AND METHODS: We performed a prospective, observational, multicenter, cohort study of 260 patients with hypophosphatemia. Blood measurements (PTH, 1,25-dihydroxyvitamin D, bone alkaline phosphatase, 25-hydroxyvitamin D, and FGF23) were performed on a Liaison XL® (DiaSorin) analyzer. RESULTS: Primary elevation of FGF23 (>95.4 pg/mL) was reported in 10.4% (95CI: 7.0-14.7) of patients (n = 27) with hypophosphatemia, suggesting that at least 1 in 10 cases of hypophosphatemia was erroneously attributed to an etiology other than FGF23 elevation. Patients with elevated blood FGF23 were grouped according to the etiology of the FGF23 elevation. Thus, 10 patients had a renal pathology, chronic kidney disease or post-renal transplantation condition. The remaining patients (n = 17) had the following etiologies: malignancies (n = 9), benign pancreatic tumor (n = 1), post-cardiac surgery (n = 4), cirrhosis (n = 2), and chronic obstructive pulmonary disease (n = 1). CONCLUSION: In order to improve patient management, it seems essential to better integrate plasma FGF23 measurement into the routine evaluation of hypophosphatemia.

Aggressive silent GH pituitary tumor resistant to multiple treatments, including temozolomide.

Temozolomide (TMZ) has been proposed as a therapeutic option in aggressive pituitary tumors. Among the published cases, GH expressing tumors were rare. We describe a patient with initially benign silent GH adenoma that transformed into an aggressive GH secreting tumor resistant to usual therapy. MGMT expression was high and the MGMT promoter was unmethylated. Before this aggressive course, patient received three cycles of TMZ; no response was observed. Four cases of GH aggressive tumor treated by TMZ have been reported. Response to TMZ was observed in one of these four patients. Predictive factors of failure of TMZ remain unclear.

[Pseudo-hypoglycemia and hyperleukocytosis: a case report]. / Pseudo-hypoglycémie et hyperleucocytose: à propos d'un cas.

Mrs B., 39 years old, hospitalized in the department of respiratory medicine for lung cancer, has an undetectable and verified venous blood glucose concentration (measured in central laboratory) less than 0.1 mmol/L. The patient feels no symptom of hypoglycemia. A concomitant capillary determination realised by a bedside glucose reader gives a result of 4.7 mmol/L. This gap is due to glucose consumption in vitro by leukocytes between the time of sampling and laboratory analysis. Indeed the leukocyte count is 86.4 G/L (92% neutrophils) probably in a context of paraneoplastic syndrome. An efficient talk between biologist and clinician identified this phenomenon for this patient. This event allows us to recall the different causes of hypoglycemia (artifactual or real), and to describe the care of patients with true hypoglycemia.