5th April 2024

A 42-year-old cleaner presents to ED with a right humeral fracture and right pubic rami fracture after falling on a mop.

A 42-year-old cleaner presents to ED with a right humeral fracture and right pubic rami fracture after falling on a mop. Orthopaedics have referred to medics for pain control and physio input. Looking at her previous admissions, you note this is her fourth fracture in three years and she has had multiple consultations with her GP for myalgia, bone pains and fatigue. 

The medical registrar with you is an endocrine trainee and takes interest in the case. They add on a bone profile, liver function test, vitamin D levels and urinary phosphate. The results confirm low serum phosphate with inappropriately high urine phosphate, low serum 1,25 dihydroxy vitamin D levels and raised alkaline phosphatase. The registrar suspects this patient has tumour induced osteomalacia and requests a PET scan. Which of the following is secreted by this tumour?  

Select the SINGLE most appropriate option from the list below. Select ONE option only.