Case of Sarcoidosis-Related Hypercalcemia with Normal Serum 1,25(OH)₂D

Abstract

Diagnosing hypercalcemia is often challenging because a wide spectrum of diseases-such as malignancy, granulomatous disease, and primary hyperparathyroidism-should be considered. Sarcoidosis is a rare cause of hypercalcemia. The case of a 77-year-old male presenting with sarcoidosis-associated hypercalcemia whose serum 1,25(OH)2D level was normal is reported here. Despite a normal 1,25(OH) 2 D level and minimally enlarged hilar lymphadenopathy, the serum angiotensin-converting enzyme (ACE) level was increased. Mediastinoscopic biopsy of the right lower paratracheal lymph node revealed pathological findings compatible with sarcoidosis. Treatment with 30 mg/day oral prednisone was started. Currently, the patient is being treated with a tapered dose of oral prednisone and small doses of vitamin D and calcium. Despite its low incidence, sarcoidosis should be considered a cause of hypercalcemia. The important diagnostic factors are not only serum calcitriol levels but also serum ACE levels and pathological findings.