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ABSTRACT: Objective: To report the effectiveness of cinacalcet in treating tertiary hyperparathyroidism (THPT) associated with chronic treatment of hypophosphatemia in a patient with fibroblast growth factor-23 (FGF-23)-mediated tumor-induced osteomalacia (TIO).Methods: We review the clinical course, imaging studies, pathology, and results of laboratory testing of our patient and review relevant literature.Results: A 52-year-old woman presented with hypercalcemia. At age 26, she developed hypophosphatemia, inappropriately low levels of calcitriol, calcium, and intact parathyroid hormone (iPTH) and was diagnosed with vitamin D–resistant osteomalacia. She was initiated on high-dose phosphate but remained hypophosphatemic and developed progressive elevation in iPTH levels along with hypercalcemia. Twenty years after the initial presentation, a mass was found on her right forearm, and surgical resection revealed a phosphaturic mesenchymal tumor diagnostic of TIO. Her hypophosphatemia resolved and she was titrated off phosphate supplements; however, the THPT persisted. Treatment with cinacalcet resulted in lowering of calcium levels and normalization of iPTH levels.Conclusion: This may be the first reported case of managing THPT associated with chronic phosphate replacement therapy without parathyroidectomy in an adult with a FGF-23–producing tumor. Medical therapy with cinacalcet should be considered in patients with THPT associated with reversible hypophosphatemia.Abbreviations: 1,25(OH)2D 1,25-dihydroxyvitamin D 18F-FDG PET/CT 18-fluorodeoxyglucose positron emission tomography/computed tomography ADHR autosomal dominant hypophosphatemic rickets ARHR autosomal recessive hypophosphatemic rickets FGF-23 fibroblast growth factor-23 iPTH intact parathyroid hormone TIO tumor-induced osteomalacia THPT tertiary hyperparathyroidism XLH X-linked hypophosphatemic rickets

ABSTRACT: Objective: We report 4 cases of iodine deficiency– induced goiter in minority women living in central New Jersey.Methods: Clinical presentations, laboratory data, thyroid 123I uptake, and thyroid sonograms were obtained from 4 minority women with iodine deficiency–induced goiter. The recent literature on the topic was also reviewed.Results: Four patients were diagnosed with iodine deficiency–induced goiter during a 4-year period in an endocrine clinic in central New Jersey. The diagnosis of iodine deficiency–induced goiter was made if the patient met the following criteria: (1) a diet history that indicated avoidance of iodized salt or seafood; (2) a 24-hour urinary iodine concentration of