Marked Hypophosphatemia with Decreased Serum 1, 25-Dihydroxyvitamin D in a Patient with Hepatocellular Carcinoma Complicating Liver Cirrhosis

Yuzo MIZUNO; Naohiko MASAKI; Hideki HASHIMOTO; Itsuro OGATA; Chikara AIZAWA; Kenji FUJIWARA; Gotaro TODA; Masaya MORI; Rikuo MACHINAMI; Kiyoshi KUROKAWA

doi:10.2169/internalmedicine1962.30.81

Yuzo MIZUNO, Naohiko MASAKI, Hideki HASHIMOTO, Itsuro OGATA, Chikara AIZAWA, Kenji FUJIWARA, Gotaro TODA, Masaya MORI, Rikuo MACHINAMI, Kiyoshi KUROKAWA

Author information

Yuzo MIZUNO
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo
Naohiko MASAKI
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo
Hideki HASHIMOTO
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo
Itsuro OGATA
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo
Chikara AIZAWA
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo
Kenji FUJIWARA
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo
Gotaro TODA
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo
Masaya MORI
Department of Pathology, Faculty of Medicine, University of Tokyo
Rikuo MACHINAMI
Department of Pathology, Faculty of Medicine, University of Tokyo
Kiyoshi KUROKAWA
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo

Keywords: Phosphaturic effect, 25-hydroxyvitamin D-l α -hydroxylase, Humoral hypercalcemia of malignancy, Oncogenic osteomalacia

JOURNAL FREE ACCESS

1991 Volume 30 Issue 1 Pages 81-86

DOI https://doi.org/10.2169/internalmedicine1962.30.81

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Abstract

A 61-year-old male with hepatocellular carcinoma (HCC) complicating liver cirrhosis presented hypophosphatemia progressing with HCC expansion and serum α-fetoprotein elevation. These changes were associated with an increased fractional excretion of phosphate and decreased theoretical phosphate threshold. There was increased nephrogenous cyclic adenosine monophosphate despite normal serum parathyroid hormone. Serum 1, 25-dihydroxyvitamin D levels were markedly reduced with normal 25-hydroxyvitamin D levels. There were no symptoms of osteomalacia, however, a slightly increased osteoid seam was elicited on autopsy. The hypophosphatemia could be explained by presumed secretion from HCC of humoral factors which have a phosphaturic effect and also inhibit 25-hydroxyvitamin D-l α -hydroxylase in renal tubular cells.

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