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Sarcoid Hypercalcaemia Treatment — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesSarcoid Hypercalcaemia TreatmentRACP Adult Medicine

A 50-year-old woman with known sarcoidosis develops progressive fatigue and polyuria. Her serum calcium is 3.2 mmol/L and creatinine is 180 µmol/L. 1,25-dihydroxyvitamin D is markedly elevated at 280 pmol/L (normal 60–180). PTH is suppressed. What is the first-line treatment for sarcoid hypercalcaemia?

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Correct answer: C — IV saline hydration then oral prednisolone

Sarcoid hypercalcaemia is caused by unregulated 1-alpha-hydroxylation of vitamin D by granulomatous macrophages. After initial IV saline rehydration, oral prednisolone (20–40 mg/day) is the definitive treatment – corticosteroids directly suppress the 1-alpha-hydroxylase in granulomas. Response is typically rapid (within days). Ketoconazole (which inhibits 1-alpha-hydroxylase) is a steroid-sparing alternative. Bisphosphonates have a secondary role. PTH is appropriately suppressed due to the hypercalcaemia.

Reference: eTG – 2025 – Endocrinology; eTG – 2025 – Respiratory