Eisen-induzierte Osteomalazie

Zusammenfassung

Das Auftreten einer invalidisierenden Osteomalazie bei einem Mann, der wegen intestinalen Angiodysplasien seit Jahren mit intravenösem Eisen behandelt wird, hat an die Rolle des Wachstumsfaktors FGF23 erinnert. FGF23 hemmt, zusammen mit PTH, die renale Phosphat-Rückresorption und führt zu Hypophosphatämie und Osteomalazie, auch weil es zudem die 25OH Vit.D 1-alpha Hydroxylase hemmt, was wiederum zu einem Mangel an 1,25(OH)2-Vitamin D führt. Die Behandlung besteht in Phosphaten und Calcitriol. Mehrere Medikamente und Krankheiten können FGF23 erhöhen: mesenchymale Tumoren, multiples Myelom, M. Hodgkin, antivirale Therapien, hypophosphatämische Osteomalazie, Nierentransplantation, intensive Wiederernährung u. a. So selten die Erhöhung des FGF23 als wesentliche Krankheitsursache auch ist, so leicht ist sie zu diagnostizieren.

Summary

The appearance of a disabling osteomalacia in a man who is treated since many years with intravenous Iron for intestinal angiodysplasia reminded the role of the growth factor FGF23. FGF23, together with PTH, inhibits renal phosphate reabsorption, and causes hypophosphatemia and by that osteomalacia, also because it inhibits the 25OH vit.D 1-alpha hydroxylase, which leads to a deficiency of 1,25(OH)2-vitamin D. The treatment consists in phosphate and Calcitriol. Several drugs and diseases can increase FGF23: mesenchyme tumours, multiple myeloma, M. Hodgkin, antiviral drugs, hypophosphatemic rickets, kidney transplantation, refeeding, etc. As rare the increase of FGF23 appears, as easy it is to recognize it.

Schlüsselwörter

Osteomalazie - FGF23 - intravenöse Eisen-Behandlung - Vitamin D - Phosphatämie

Keywords

Osteomalacia - FGF23 - intravenous iron treatment - Vitamin D - phosphatemia

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