Improving diagnosis of tumor-induced osteomalacia with gallium-68 DOTATATE PET/CT

Clifton-Bligh, Roderick, Hofman, Michael S., Duncan, Emma L., Sim, Ie-Wen, Darnell, David, Clarkson, Adele, Wong, Tricia, Walsh, John P., Gill, Anthony J., Ebeling, Peter R., & Hicks, Rodney J. (2013) Improving diagnosis of tumor-induced osteomalacia with gallium-68 DOTATATE PET/CT. Journal of Clinical Endocrinology and Metabolism, 98(2), pp. 687-694.

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Tumor-induced osteomalacia (TIO) is a rarely diagnosed disorder presenting with bone pain, fractures, muscle weakness, and moderate-to-severe hypophosphatemia resulting from fibroblast growth factor 23-mediated renal phosphate wasting. Tumors secreting fibroblast growth factor 23 are often small and difficult to find with conventional imaging.


We studied the utility of 68Ga-DOTA-octreotate (DOTATATE) somatostatin receptor positron emission tomography (PET)/computed tomography (CT) imaging in the diagnosis of TIO.

Design and Setting:

A multicenter case series was conducted at tertiary referral hospitals.

Patients and Methods:

Six patients with TIO diagnosed between 2003 and 2012 in Australia were referred for DOTATATE PET imaging. We reviewed the clinical history, biochemistry, imaging characteristics, histopathology, and clinical outcome of each patient.


Each case demonstrated delayed diagnosis despite severe symptoms. DOTATATE PET/CT imaging demonstrated high uptake and localized the tumor with confidence in each case. After surgical excision, there was resolution of clinical symptoms and serum phosphate, except in one patient who demonstrated residual disease on PET/CT. All tumors demonstrated high somatostatin receptor subtype 2 cell surface receptor expression using immunohistochemistry.


In patients with TIO, DOTATATE PET/CT can successfully localize phosphaturic mesenchymal tumors and may be a practical first step in functional imaging for this disorder. Serum phosphate should be measured routinely in patients with unexplained muscle weakness, bone pain, or stress fractures to allow earlier diagnosis of TIO. - See more at:

Impact and interest:

20 citations in Scopus
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16 citations in Web of Science®

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ID Code: 94196
Item Type: Journal Article
Refereed: Yes
Keywords: 25 hydroxyvitamin D, alkaline phosphatase, calcitriol, colecalciferol, fibroblast growth factor 23, galluim tetraxetan octreotate ga 68, parathyroid hormone, phosphate, somatostatin receptor 2, tracer, unclassified drug, adult, aged, article, Australia, benign tumor, bone biopsy, bone pain, bone scintiscanning, clinical article, computer assisted emission tomography, delayed diagnosis, diagnostic imaging, disease severity, female, histopathology, human, human tissue, hypophosphatemia, immunohistochemistry, male, medical history, minimal residual disease, oncogenic osteomalacia, orthopedic surgery, osteomalacia, outcome assessment, phosphate blood level, phosphaturia, physical examination, priority journal, protein expression, rib fracture, stress fracture, tumor localization, vitamin blood level, vitamin D deficiency, Gallium Radioisotopes, Humans, Middle Aged, Neoplasms, Connective Tissue, Octreotide, Organometallic Compounds
DOI: 10.1210/jc.2012-3642
ISSN: 0021-972X
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Deposited On: 29 Mar 2016 00:52
Last Modified: 30 Mar 2016 01:38

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