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Presentation of Case
Dr. Eric Hesse (Harvard School of Dental Medicine): A 56-year-old man was seen in the outpatient endocrinology and oral-surgery clinics of this hospital because of recurrent hypophosphatemia.
The patient had been well until 19 years earlier, when rib pain developed and a left metatarsal stress fracture occurred while he was running. Laboratory tests performed 1 year later at another hospital revealed normal levels of serum creatinine and bicarbonate and normal creatinine clearance, and urine tests for organic or amino acids were negative; other test results are shown in Table 1. Radiographs of the left forefoot showed Looser zones . . .
Dr. Rosenberg reports receiving consulting fees from Genzyme. No other potential conflict of interest relevant to this article was reported.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Discussed at the Medicine Grand Rounds.
We thank Dr. Lloyd Axelrod for assistance in organizing the conference and for reviewing an earlier draft of the manuscript.
Source Information
From the Division of Endocrinology (C.W.H.B.) and the Departments of Radiology (R.S.K.) and Pathology (A.E.R.), Massachusetts General Hospital; and the Departments of Medicine (C.W.H.B.), Radiology (R.S.K.), and Pathology (A.E.R.), Harvard Medical School — both in Boston; and the Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD (M.T.C.).
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