PURPOSE:Hypercalcemia is a well recognized complication of sarcoidosis with the most commonly cited reason increased levels of vitamin D3–1,25. We studied the frequency, complications, and clinical outcome of hypercalcemia in sarcoidosis patients followed at one clinic.
METHODS:The records were reviewed from sarcoidosis patients seen at the Interstitial Lung Disease and Sarcoidosis Clinic at the University of Cincinnati Medical Center over a five year period. Laboratory testing, including serum calcium and creatinine, was noted for each patient, and the highest serum calcium was analyzed. Upper limit of normal calcium is 10.2 mg% for our laboratory. Therefore patients whose highest serum calcium was 10.3 mg% or greater were considered hypercalcemic and compared to those without hypercalcemia (Control).
RESULTS:During the five years of study, 1587 sarcoidosis patients (1101 females, 486 male) were seen at least once. Of these, 1573 were self described as either Caucasians (922 patients) or African-American (651 patients). Hyercalcemia was identified in 109 patients. Eight of these hypercalcemic patients had primary hyperparathyroidism. Of the remaining 101 hypercalcemic patients (6.4% of the total), 71 were female and 67 were Caucasian. No gender or racial difference was noted in the proportion of hypercalcemic versus control patients. Of the hypercalcemic sarcoidosis patients, thirty had elevated serum creatinine levels at the time of hypercalcemia. With treatment, serum calcium levels normalized in most patients. In contrast, while the elevated creatinine improved, many patients were left with residual renal dysfunction. Those patients with persistent hypercalcemia either had primary hyperparathyroidism or were taking supplemental calcium.
CONCLUSION:Hypercalcemia can be seen in both African American as well as Caucasian sarcoidosis patients. It can lead to renal dysfunction. Hypercalcemia resistant to sarcoidosis treatment may be due to excessive supplemental calcium. In some cases, primary hyperparathyroidism led to refractory hypercalcemia.
CLINICAL IMPLICATIONS:Hypercalcemia in sarcoidosis patients requires careful evaluation as it usually responds to appropriate therapy.
DISCLOSURE:Malia Ray, No Financial Disclosure Information; No Product/Research Disclosure Information