London ECIA 7BE

SUMMARY A case of adult Fanconi syndrome is described in which there was urinary excretion of K light chains. After 13 years the patient developed overt myeloma. She also developed an adenocarcinoma of the colon and an adenocarcinoma of the parathyroid gland. These findings are discussed in relation to the known association between adult Fanconi syndrome, renal damage, and myeloma. Adult Fanconi syndrome consists of a group of abnormalities resulting from dysfunction of the pro-ximal renal tubules. These include glycosuria, phos-phaturia, aminoaciduria, acidosis, and often osteomalacia. ' 2 Twenty patients have been described in the published work'-8 with adult Fan-coni syndrome and Bence Jones proteinuria, due to K light chains in all cases typed. These patients fall into two groups: in 13 patients adult Fanconi syn-drome preceded the development of myeloma or amyloidosis often by many years, whereas in seven patients the syndrome and myeloma were diagnosed simultaneously. It has been suggested that patients with adult Fanconi syndrome and Bence Jones pro-teinuria who develop myeloma or amyloidosis con-stitute a distinct type of monoclonal gammopathy.2 The case reported here had a history which termi-nated in myeloma after 13 years. In addition, she developed two adenocarcinomas: that of the colon was removed surgically while that of the parathyroid gland was discovered at necropsy. Case report A 53 year old white woman presented in August 1967 with a six week history of bone pain. There were no abnormal physical signs, although she had had some difficulty in walking for 10 months. Results of biochemical and radiological examina-tions are shown in the Table. Adult Fanconi syn-drome was diagnosed on the basis of persisten