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Sarcoidosis hypercalcemia — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Sarcoidosis hypercalcemiaUSMLE Step 3

A 55-year-old woman with sarcoidosis has fatigue, constipation, and polyuria. Calcium is 12.1 mg/dL, phosphate is 4.8 mg/dL, PTH is low, 25-hydroxyvitamin D is normal, and 1,25-dihydroxyvitamin D is elevated. Creatinine is 1.2 mg/dL. Which of the following is the most appropriate next step in management?

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Correct answer: E — Glucocorticoid therapy after hydration

Granulomatous macrophage activation of vitamin D causes PTH-independent hypercalcemia in sarcoidosis. Initial hydration is followed by glucocorticoids when clinically significant or persistent.

Reference: Endocrine Society hypercalcemia principles; ATS Sarcoidosis guidance