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.
Hypophosphatemia can be a common electrolyte problem in the acute hospital setting, but it can also be seen in outpatient clinics. The symptoms of hypophosphatemia are varied depending on the level and rate of depletion and are non-specific, therefore the diagnosis is usually based on biochemical findings.
The causes are also numerous, and it is useful for the clinician to have a diagnostic road map on how to investigate this. In this case report, we describe an unusual diagnosis of malignant mesothelioma resulting from the investigations for hypophosphatemia. We also suggest a pragmatic method for the diagnostic workup of hypophosphatemia, which can be used in a busy clinical setting….
This case report described a case of mesothelioma diagnosed after having investigations for hypophosphatemia. This may be coincidental rather than the causative factor of hypophosphatemia. A clear diagnostic approach may help in arriving at a diagnosis sooner. It is important to remember to test the blood phosphate level on a fasting sample. A detailed pharmacological history will prevent unnecessary investigations if the cause is found in the medications being taken by the patient. We also highlight the importance of investigations for increased urinary loss causing hypophosphatemia; otherwise, it would be possible to miss a serious diagnosis in patients such as tumor-induced osteomalacia.
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