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Sarcoidosis Hypercalcaemia — ESENeph MCQ

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ModerateElectrolyte DisordersSarcoidosis HypercalcaemiaESENeph

A 35-year-old man with normal kidney function (eGFR 95 mL/min/1.73m2) presents with severe hypercalcaemia (corrected Ca 3.4 mmol/L) causing confusion and dehydration. PTH is suppressed. 1,25-dihydroxyvitamin D is markedly elevated. He has no known malignancy. Chest X-ray shows bilateral hilar lymphadenopathy. What is the first-line treatment?

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Correct answer: A — IV normal saline followed by Glucocorticoids

Hypercalcaemia with suppressed PTH, elevated 1,25-dihydroxyvitamin D, and bilateral hilar lymphadenopathy is diagnostic of sarcoidosis. First-line treatment is aggressive IV fluid resuscitation (0.9% saline) for dehydration and dilutional calcium reduction, followed by Glucocorticoids (Prednisolone 20-40 mg). Glucocorticoids directly inhibit the 1-alpha-hydroxylase in granulomas that is producing excess 1,25-dihydroxyvitamin D. IV bisphosphonates are less effective for granulomatous hypercalcaemia than for PTHrP-mediated malignant hypercalcaemia.

Reference: https://guidelines.ukkidney.org