La Revue de médecine interne
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Case Reports
[Oncogenic osteomalacia: increased production of fibroblast growth factor 23 is not the unique actor].
The importance of fibroblast growth factor 23 (FGF 23) has been highlighted in the mechanism of urinary leakage of phosphate in the oncogenic osteomalacia (OO). It is now a component of diagnosis of this disease. We report a 58-year-old man who presented with osteomalacia and hypophosphatemia secondary to urinary leakage of phosphorus. ⋯ The importance of functional sequelae in OO depends on prompt diagnosis. Tumorectomy remains the optimal treatment. Thus, the search for a secreting tumor is essential even in the absence of elevated serum FGF 23.
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Valproate is a drug commonly prescribed in neurology and psychiatry. Hyperammonemic encephalopathy due to valproate is a severe complication. A 44-year-old man with a past medical history of partial symptomatic epilepsy and alcoholic cirrhosis was admitted for drowsiness. ⋯ No correlation has been shown between the severity of encephalopathy, the plasma ammonium level, the valproate dose and its plasma concentration. Additional factors have been pointed out, such as carnitine deficiency or urea cycle enzyme defects. Furthermore, our case suggests an enhancing role of the liver disease in this encephalopathy.