Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis

Zhou, Ying; Lower, Elyse E.

doi:10.1055/s-0040-1713009

Cited by 9 publications

(4 citation statements)

References 71 publications

(81 reference statements)

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“…If confirmed by further studies, these findings suggest that patients with persistently elevated serum ACE levels should be monitored carefully for supervening lymphoma [36]. Another feature supportive of sarcoidosis is an elevated serum calcium with an elevated vitamin D 1,25 and low vitamin D 25 and parathyroid hormone [37 ▪▪ ,38]. However, this biomarker quartet has rarely been described in lymphoma [39].…”

Section: Proposed Evaluation For a Cancer Patient With Granulomas Ide...mentioning

confidence: 85%

Sarcoidosis and maligancy: the chicken and the egg?

Bonifazi¹,

Renzoni

Lower

2021

Current Opinion in Pulmonary Medicine

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Purpose of reviewThere is a complex interaction between sarcoidosis and malignancy. Since tumors can elicit a granulomatous reaction, the presence of granulomas alone is insufficient to diagnose sarcoidosis in a patient with cancer. In addition, check point inhibitors can also lead to a granulomatous reaction which can be misdiagnosed as sarcoidosis. These issues need to be considered when exploring the relationship between sarcoidosis and malignancy. Despite these limitations, a growing amount of evidence supports the potential interaction of sarcoidosis and malignancy.Recent findingsSeveral large epidemiologic studies of patients from Europe, the USA, and Japan reveal an increased relative risk for cancer in sarcoidosis patients. The highest relative risks are seen in patients with lymphoma and breast cancer. New criteria have been developed to standardize the diagnosis of sarcoidosis, which should further clarify the association.SummaryThe diagnosis of sarcoidosis may precede or occur after malignancy. In a sarcoidosis patient with an atypical lesion, such as a breast mass, a biopsy should be considered.

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Section: Proposed Evaluation For a Cancer Patient With Granulomas Ide...mentioning

confidence: 85%

Sarcoidosis and maligancy: the chicken and the egg?

Bonifazi¹,

Renzoni

Lower

2021

Current Opinion in Pulmonary Medicine

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“…Stopping supplementation in patients with sarcoidosis who develop mild asymptomatic hypercalcaemia is effective 12. In those with abnormal calcium metabolism, reduced bone mineral density or fragility fractures, treatment with bisphosphonates or other anti-resorptive agents is recommended 13. The attendant risks with supplementing vitamin D in patients with sarcoidosis can make physicians hesitant to prescribe it.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D-induced hypercalcaemia and acute kidney injury in sarcoidosis

et al. 2023

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Vitamin D deficiency is relatively common, and its management in patients with sarcoidosis is challenging due to the risk of hypercalcaemia. Our patient had an autologous stem cell transplant for multiple sclerosis and was given high-dose vitamin D concurrently with immunosuppressive therapy. The patient subsequently presented with symptomatic hypercalcaemia and an acute kidney injury. A clinical and biochemical recovery was reached by withdrawing vitamin D and administering intravenous fluids. Interestingly, new evidence suggests that activated vitamin D can actually dampen the inflammatory process in sarcoidosis, and this was reflected in a reduction of our patient’s serological markers of sarcoidosis activity. One large study found no significant risk of hypercalcaemia when low doses of vitamin D were used in sarcoidosis. Where indicated, and until clear guidelines are established, we suggest using low doses of vitamin D with cautious monitoring of calcium and renal function.

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“…Bone Health [148][149][150] Counsel patients about the risk of osteoporosis and screen for risk factors. Baseline DEXA scan (for patients anticipated to need glucocorticoids for >3 months).…”

Section: Medication-related and Complication-related Hrqolmentioning

confidence: 99%

“…Monitoring of electrolytes. Bone Health [148][149][150] Cardiovascular [148] Baseline lipid panel. Blood pressure monitoring and treatment of hypertension if indicated.…”

Section: Medication-related and Complication-related Hrqolmentioning

confidence: 99%

Health-Related Quality of Life (HRQoL) in Sarcoidosis: Diagnosis, Management, and Health Outcomes

et al. 2021

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Health-related quality of life (HRQoL), though rarely considered as a primary endpoint in clinical trials, may be the single outcome reflective of patient priorities when living with a health condition. HRQoL is a multi-dimensional concept that reflects the degree to which a health condition interferes with participation in and fulfillment of important life areas. HRQoL is intended to capture the composite degree of physical, physiologic, psychological, and social impairment resulting from symptom burden, patient-perceived disease severity, and treatment side effects. Diminished HRQoL expectedly correlates to worsening disability and death; but interventions addressing HRQoL are linked to increased survival. Sarcoidosis, being a multi-organ system disease, is associated with a diffuse array of manifestations resulting in multiple symptoms, complications, and medication-related side effects that are linked to reduced HRQoL. Diminished HRQoL in sarcoidosis is related to decreased physical function, pain, significant loss of income, absence from work, and strain on personal relationships. Symptom distress can result clearly from a sarcoidosis manifestation (e.g., ocular pain, breathlessness, cough) but may also be non-specific, such as pain or fatigue. More complex, a single non-specific symptom, e.g., fatigue may be directly sarcoidosis-derived (e.g., inflammatory state, neurologic, hormonal, cardiopulmonary), medication-related (e.g., anemia, sleeplessness, weight gain, sub-clinical infection), or an indirect complication (e.g., sleep apnea, physical deconditioning, depression). Identifying and distinguishing underlying causes of impaired HRQoL provides opportunity for treatment strategies that can greatly impact a patient’s function, well-being, and disease outcomes. Herein, we present a reference manual that describes the current state of knowledge in sarcoidosis-related HRQoL and distinguish between diverse causes of symptom distress and other influences on sarcoidosis-related HRQoL. We provide tools to assess, investigate, and diagnose compromised HRQoL and its influencers. Strategies to address modifiable HRQoL factors through palliation of symptoms and methods to improve the sarcoidosis health profile are outlined; as well as a proposed research agenda in sarcoidosis-related HRQoL.

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Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis

Cited by 9 publications

References 71 publications

Sarcoidosis and maligancy: the chicken and the egg?

Sarcoidosis and maligancy: the chicken and the egg?

Vitamin D-induced hypercalcaemia and acute kidney injury in sarcoidosis

Health-Related Quality of Life (HRQoL) in Sarcoidosis: Diagnosis, Management, and Health Outcomes

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