Scimago Lab
powered by Scopus
call: +1.631.470.9640
Mon-Fri 10 am - 2 pm EST


Medical Science Monitor Basic Research


eISSN: 1643-3750

Get your full text copy in PDF

Hypercalcemia as a result of sarcoidosis with normal serum concentrations of vitamin D

Stefan Falk, Juergen Kratzsch, Ralf Paschke, Christian A Koch

Med Sci Monit 2007; 13(11): CS133-136

ID: 512936

Background:    Hypercalcemia can occur in patients with granulomatous disorders such as sarcoidosis, and is commonly related to high serum 1,25-dihydroxyvitamin D (OHD) concentrations.
    Case Report:    We here report a 68-year-old man with a history of mild renal insufficiency who presented with hypercalcemia (serum calcium of 3.11 mmol) and normal 1,25-OHD levels (38 pg/ml, RIA/IDS, Boldon, UK, measuring both 1,25-OH D2 and D3). Imaging and laboratory investigations were suggestive of sarcoidosis. After hydration and prednisone therapy (40 mg/day) for 7 days, serum calcium dropped to 2.7 mmol and 1,25-OHD levels to 13.4 pg/ml. Six weeks after prednisone therapy, serum calcium was 2.41 mmol (normal) and 1,25-OHD 6.2 pg/ml (low). Computed tomography of the chest showed shrinkage of the right hilar mass.
    Conclusions:    This case illustrates that hypercalcemia can occur in granuloma-forming disorders such as sarcoidosis in the setting of inappropriately normal (and not elevated) 1,25-OHD levels. Contributing factors may include dehydration, increased uptake of oral calcium and/or decreased calcium excretion, especially in mild renal insufficiency. Therapy of choice are hydration and glucocorticoid (prednisone) therapy. In this setting, prednisone may lead to a decline of activated mononuclear cells (in the lung and lymph nodes) that are able to produce extrarenal PTH-independent 1,25-OHD.

Keywords: Calcium - blood, Calcitriol - blood, Hypercalcemia - etiology, Kidney Failure, Chronic - complications, Parathyroid Hormone - blood, Prednisone - therapeutic use, Sarcoidosis, Pulmonary - drug therapy, Vitamin D - blood

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
I agree