{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T08:08:14Z","timestamp":1789546094724,"version":"build-2803163510"},"reference-count":16,"publisher":"The Endocrine Society","issue":"10","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Markedly elevated bone-specific alkaline phosphatase with radiographic skeletal abnormalities is a common endocrine presentation, most often attributed to disorders with high bone turnover, including Paget disease of bone or osteomalacia. Rarely, tumor-driven osteoblastic metastases may closely mimic this biochemical and radiographic phenotype, thereby potentially delaying the diagnosis of occult malignancy. This report describes a 50-year-old woman presenting with progressive dyspnea and constitutional symptoms who was found to have massive pericardial effusion with cardiac tamponade requiring pericardiocentesis. Imaging revealed diffuse osteosclerotic lesions with axial skeleton involvement. Laboratory examination showed markedly elevated alkaline phosphatase with a disproportionately high bone-specific component, alongside mild hypocalcemia, secondary hyperparathyroidism, and severe vitamin D deficiency, initially suggesting a high\u2013bone-turnover metabolic bone disorder. However, whole-body fluorine-18 fluorodeoxyglucose positron emission tomography\/computed tomography (18F-FDG PET\/CT) demonstrated multiple sclerotic skeletal lesions with mild homogeneous marrow uptake, suggesting metastatic disease. Upper gastrointestinal endoscopy identified a lesion in gastric antrum, and biopsy confirmed poorly differentiated signet-ring cell adenocarcinoma. Bone marrow biopsy established metastasis, confirming stage IV disease with diffuse osteoblastic skeletal metastases. This case highlights tumor-mediated osteoblastic activity as an important endocrine mimic and underscores the need to integrate biochemical, radiologic, and histopathologic findings for the timely diagnosis of underlying malignancy.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag269","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:30:41Z","timestamp":1788521441000},"source":"Crossref","is-referenced-by-count":0,"title":["Osteoblastic skeletal metastases mimicking high\u2013bone-turnover metabolic bone disease in gastric adenocarcinoma"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6480-1411","authenticated-orcid":false,"given":"Sai Meghana","family":"Madala","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Sri Ramachandra Institute of Higher Education and Research , Chennai 600116 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2741-2633","authenticated-orcid":false,"given":"Asha","family":"Ranjan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Sri Ramachandra Institute of Higher Education and Research , Chennai 600116 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkateswarlu","family":"Damacharlla","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Sri Ramachandra Institute of Higher Education and Research , Chennai 600116 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadhanandham","family":"Shanmugasundaram","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research , Chennai 600116 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkata Sai","family":"Pulivadula Mohanarangam","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sri Ramachandra Institute of Higher Education and Research , Chennai 600116 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena","family":"Dennis Joseph","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sri Ramachandra Institute of Higher Education and Research , Chennai 600116 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"24","key":"2026091603530380500_luag269-B1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11247306","article-title":"Bone metastases from gastric cancer resembling Paget's disease: a case report","volume":"11","author":"Aiba","year":"2022","journal-title":"J Clin Med"},{"issue":"6","key":"2026091603530380500_luag269-B2","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1007\/s40618-024-02318-1","article-title":"Diagnosis and treatment of Paget's disease of bone: position paper from the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS)","volume":"47","author":"Rendina","year":"2024","journal-title":"J Endocrinol Invest"},{"issue":"1","key":"2026091603530380500_luag269-B3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.5001\/omj.2013.02","article-title":"Multiple myeloma: an update","volume":"28","author":"Al-Farsi","year":"2013","journal-title":"Oman Med J"},{"key":"2026091603530380500_luag269-B4","volume-title":"Osteomalacia","author":"Zimmerman","year":"2024"},{"issue":"12","key":"2026091603530380500_luag269-B5","article-title":"Osteoblastic lesions as the first presentation of a gastric mixed-type adenocarcinoma: a case report","volume":"15","author":"de Almeida","year":"2023","journal-title":"Cureus"},{"issue":"26","key":"2026091603530380500_luag269-B6","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000029731","article-title":"Severe and refractory hypocalcaemia secondary to osteoblastic bone metastases in bladder signet ring carcinoma: a case report and literature review","volume":"101","author":"Zeng","year":"2022","journal-title":"Medicine (Baltimore)"},{"issue":"3","key":"2026091603530380500_luag269-B7","doi-asserted-by":"crossref","first-page":"270","DOI":"10.3325\/cmj.2021.62.270","article-title":"The pathogenesis of bone metastasis in solid tumors: a review","volume":"62","author":"Vi\u010di\u0107","year":"2021","journal-title":"Croat Med J"},{"key":"2026091603530380500_luag269-B8","volume-title":"Physiology, Parathyroid Hormone","author":"Khan","year":"2026"},{"issue":"17","key":"2026091603530380500_luag269-B9","doi-asserted-by":"crossref","first-page":"3396","DOI":"10.7150\/jca.21017","article-title":"Clinicopathological characteristics and prognostic value of signet ring cells in gastric carcinoma: a meta-analysis","volume":"8","author":"Nie","year":"2017","journal-title":"J Cancer"},{"issue":"3","key":"2026091603530380500_luag269-B10","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1002\/1097-0142(20010801)92:3<634::AID-CNCR1364>3.0.CO;2-X","article-title":"Expression of glucose transporter-1 in human gastric carcinoma: association with tumor aggressiveness, metastasis, and patient survival","volume":"92","author":"Kawamura","year":"2001","journal-title":"Cancer"},{"issue":"4","key":"2026091603530380500_luag269-B11","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4251\/wjgo.v3.i4.67","article-title":"Primary gastric signet ring cell carcinoma presenting as cardiac tamponade","volume":"3","author":"Huang","year":"2011","journal-title":"World J Gastrointest Oncol"},{"issue":"1","key":"2026091603530380500_luag269-B12","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40959-024-00207-3","article-title":"Pericardial effusion in oncological patients: current knowledge and principles of management","volume":"10","author":"Mori","year":"2024","journal-title":"Cardio-Oncology"},{"issue":"3","key":"2026091603530380500_luag269-B13","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1378\/chest.118.3.744","article-title":"Prognostic role of pericardial fluid cytology in cardiac tamponade associated with non-small cell lung cancer","volume":"118","author":"Wang","year":"2000","journal-title":"Chest"},{"issue":"Suppl 1","key":"2026091603530380500_luag269-B14","doi-asserted-by":"crossref","first-page":"S237","DOI":"10.4103\/jcrt.JCRT_834_18","article-title":"Gastric signet ring cell carcinoma presenting with widespread osteoblastic metastases","volume":"16","author":"Soylu","year":"2020","journal-title":"J Cancer Res Ther"},{"issue":"3","key":"2026091603530380500_luag269-B15","doi-asserted-by":"crossref","first-page":"164","DOI":"10.5230\/jgc.2014.14.3.164","article-title":"Bone metastasis from gastric cancer: the incidence, clinicopathological features, and influence on survival","volume":"14","author":"Turkoz","year":"2014","journal-title":"J Gastric Cancer"},{"issue":"7","key":"2026091603530380500_luag269-B16","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.ejca.2010.02.041","article-title":"Bisphosphonates and RANK ligand inhibitors for the treatment and prevention of metastatic bone disease","volume":"46","author":"Neville-Webbe","year":"2010","journal-title":"Eur J Cancer"}],"container-title":["JCEM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/4\/10\/luag269\/71115229\/luag269.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/4\/10\/luag269\/71115229\/luag269.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:53:12Z","timestamp":1789545192000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcemcr\/article\/doi\/10.1210\/jcemcr\/luag269\/8800983"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,9,3]]}},"URL":"https:\/\/doi.org\/10.1210\/jcemcr\/luag269","relation":{},"ISSN":["2755-1520"],"issn-type":[{"value":"2755-1520","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,3]]},"article-number":"luag269"}}