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Hypercalcaemia in sarcoidosis — SCE Rheumatology MCQ

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HardMetabolic Bone DiseaseHypercalcaemia in sarcoidosisSCE Rheumatology

A patient with sarcoidosis has renal colic, calcium 2.94 mmol/L, suppressed PTH and raised 1,25-dihydroxyvitamin D. What is the mechanism?

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Correct answer: E — Granulomatous extrarenal calcitriol production causing hypercalcaemia

Activated macrophages in sarcoid granulomas express 1-alpha-hydroxylase outside normal renal feedback, increasing calcitriol and intestinal calcium absorption. Hypercalcaemia or hypercalciuria can cause stones and renal impairment.

Reference: BTS clinical statement on pulmonary sarcoidosis (Published 2020): https://www.brit-thoracic.org.uk/clinical-resources/clinical-statements/sarcoidosis/; NICE NG132: primary hyperparathyroidism — recommendations (Published May 2019): https://www.nice.org.uk/guidance/ng132/chapter/Recommendations