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Sarcoidosis hypercalcaemia — SCE Endocrinology MCQ

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HardCalcium/BoneSarcoidosis hypercalcaemiaSCE Endocrinology

A man with sarcoidosis has confusion, dehydration, adjusted calcium 3.18 mmol/L, suppressed PTH and raised calcitriol. After initial saline, which cause-directed treatment is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Glucocorticoids to suppress granulomatous calcitriol production

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · E = shown as D · B = shown as E

C is correct. Activated macrophages in granulomas produce extrarenal 1α-hydroxylase, raising calcitriol despite suppressed PTH. Rehydrate first, then glucocorticoids reduce calcitriol production; an IV bisphosphonate may be needed according to severity and response. Cinacalcet and parathyroidectomy target PTH-mediated disease, while calcitriol or teriparatide would aggravate hypercalcaemia.

Reference: https://www.endocrinology.org/media/4277/emergency-guidance_acute-hypercalcaemia-in-adults.pdf