3rd INTERNATIONAL WORKSHOP ON PHOSPHATE AND OTHER MINERALS
Madrid, Spain – July 13-15, 1977
MILD PHOSPHATE DIABETES IN ADULTS.
Erik Lundberg, Harald Bergengren and Bengt Lindqvist, J Departments of Rheumatology, Pathology and Medicine, University of Umeå, S-901 87 Umeå, Sweden.
Phosphate diabetes can be defined as hyperphosphaturia and hypophosphataemia without concomitant calcium disturbance or increased parathyroid hormone concentration. The condition has been considered as very rare and to occur almost exclusively in children.
Upon examination of adult patients with rheumatic or kidney diseases it is found however that the combination hypophosphataemia and hyperphosphaturia is not so rare. We have met 23 patients within 6 months of whom the majority had only mild phosphate diabetes.
The diagnoses for these patients have varied considerably. In the material are to be found patients with myalgia and dorsalgia (6-cases), prostatitis or prostate accretion (4 cases), papillitis calcificans (3 cases), renal calculi (2 cases), tubular defect (2cases), status after kidney transplantation (2 cases), dizziness (2 cases), interstitial nephritis or medullary sponge kidney (one case each). Asthenia is often an additional diagnosis.
The patients complaints have, however, been similar, muscular weakness, muscle pain, joint pain, bone tenderness, tiredness, dizziness, paresthesias. Upon examination the most common findings have been bone tenderness, tender muscles, occasional reduced manual power, positive Romberg test and waddling gait. Besides hypophosphataemia and hyperphosphaturia the most common laboratory findings are high pH in the urine and phosphate crystals in dried urine.
The etiology and pathogenesis of this type of phosphate diabetes is far from clear, Plausible causes are a hormonal factor and a tubular defect, or a combination of both. An additional factor in initiating the condition can also be a dietary phosphate deficiency or a poor phosphate reserve in the body.
The duration of phosphate diabetes varies from several weeks to several years and the degree also varies. At present, the condition is poorly defined and the diagnosis clearly neglected. We have treated our patients with (Ca-, K-, Na-, Mg-) phosphate tablets and sometimes also I-alpha-hydroxycholecalciferol, with good short-term effect.
Department of Pathology
University of Umeå
S-901 87 UMEÅ