Sarcoidosis and primary hyperparathyroidism simultaneously occurring in a hypercalcemic patient

Hassan, Syed Adeel; Amer, Syed; Swamy, Vinushree; Rao, Sudhaker D

doi:10.4103/2230-8210.103050

Cited by 9 publications

(3 citation statements)

References 4 publications

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“…Moreover, prednisone efficiently prevents intestinal calcium absorption when hypercalcaemia results from sarcoidosis. Thus, in this case, an associated cause of hypercalcaemia, for example, primary hyperparathyroidism, is to be investigated first [26]. In our case, another cause, such as Graves' disease, was eventually shown.…”

Section: Discussionmentioning

confidence: 75%

Management of sarcoidosis in clinical practice

et al. 2016

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Sarcoidosis is a systemic disease of unknown cause with very diverse presentation, outcome, severity and need for treatments. While some presentations may be very typical, for many patients, the presentation is nonspecific, with shared associations with other diseases at times being by far more frequent or misleading, which can be a cause of significant delay and often several consultations before a diagnosis of sarcoidosis can be confirmed. This is particularly the case when pulmonary manifestations are in the forefront. The diagnosis relies on three well-known criteria. In clinical practice, these criteria are not easily implemented, particularly by physicians without expertise in sarcoidosis, which can lead to a risk of either under-or over-diagnosis. Qualifying the presentation according to sarcoidosis diagnosis is essential. However, it is often not easy to classify the presentation as typical versus compatible or compatible versus inconsistent. Further investigations are needed before any other hypothesis is to be considered. It is important to detect events and to determine whether or not they are indicative of a flare of sarcoidosis. Eventually, treatment needs to be related to the correct indications. The evaluation of the efficacy and safety of treatments is crucial. To address such issues, we present five emblematic cases that illustrate this. @ERSpublications Showing emblematic cases is the best way to illustrate the multiple conditions to deal with for managing sarcoidosis http://ow.ly/10A5Yv

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Section: Discussionmentioning

confidence: 75%

Management of sarcoidosis in clinical practice

et al. 2016

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“…Hypercalcemia is present in sarcoidosis due to the activation of 1-alpha-hydroxylase by sarcoid granulomas leading to the conversion of 25-OH vitamin D to the active form of vitamin D,1,25-(OH)2 vitamin D. The active form of vitamin D increases gut calcium absorption and resorption of calcium from bones. In hyperparathyroidism, PTH promotes renal 1-alphahydroxylation of vitamin D and activation of osteoclasts leading to increased bone resorption [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Acute inflammatory arthropathy and hypercalcemia leading to a diagnosis of primary hyperparathyroidism in a patient with known sarcoidosis

Larsen,

Guma,

Mehannek

et al. 2023

Cureus

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Calcium pyrophosphate deposition disease (CPPD) is a crystal-induced arthropathy characterized by calcium pyrophosphate crystal deposition in joints and soft tissues. The diagnosis is suggested by the presence of chondrocalcinosis on x-ray but is most often diagnosed by synovial fluid analysis (SFA). CPPD is associated with aging and metabolic disorders such as hyperparathyroidism. In this case, we present an 87-year-old woman with known sarcoidosis who presented with acute arthropathy, hypercalcemia, and radiographic evidence of CPPD. Her hypercalcemia had been attributed to her sarcoidosis in the past without a full workup. Hypercalcemia in the setting of suspected CPPD led to a full workup for hypercalcemia and ultimately led to a diagnosis of primary hyperparathyroidism. This case highlights the importance of a complete evaluation for hypercalcemia in the setting of CPPD, even when another disease, such as sarcoidosis, could explain hypercalcemia. Ultimately, CPPD aided in diagnosing hyperparathyroidism in our patient with known sarcoidosis.

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“…The patient was treated with parathyroidectomy and glucocorticoids with marked improvement. Interestingly, the occurrence of PHPT and sarcoidosis simultaneously in a single patient has been seldom reported in the literature [ 8 ]. We aim to provide insight into the clinical and radiological presentation of these patients, as well as the therapeutic approach for both conditions.…”

Section: Introductionmentioning

confidence: 99%

Concurrent Primary Hyperparathyroidism and Sarcoidosis in a Patient With Severe Hypercalcemia

Ayyad,

Khaleel,

Albandak

et al. 2023

Cureus

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Hypercalcemia is a common biochemical abnormality caused by various etiologies, with primary hyperparathyroidism (PHPT) and malignancies being the most common culprits. Differentiating between PTH-dependent and PTH-independent hypercalcemia is crucial in clinical practice. However, in certain clinical contexts, it is important to consider the rare occurrence of two separate conditions causing hypercalcemia simultaneously. Herein, we have described the case of a patient who presented with high serum calcium, a normal PTH level, and histopathological evidence of active granulomatous disease, indicating the presence of both PHPT and sarcoidosis. The coexistence of these conditions poses diagnostic challenges due to their biochemical and clinical similarities. This case highlights the importance of individualized management for patients with concurrent conditions contributing to hypercalcemia. It also emphasizes the need for further research to unravel the underlying interactions between PHPT and sarcoidosis in the context of calcium metabolism. A better understanding of these interactions can guide optimal diagnostic and therapeutic strategies for patients with complex presentations of hypercalcemia.

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Sarcoidosis and primary hyperparathyroidism simultaneously occurring in a hypercalcemic patient

Cited by 9 publications

References 4 publications

Management of sarcoidosis in clinical practice

Management of sarcoidosis in clinical practice

Acute inflammatory arthropathy and hypercalcemia leading to a diagnosis of primary hyperparathyroidism in a patient with known sarcoidosis

Concurrent Primary Hyperparathyroidism and Sarcoidosis in a Patient With Severe Hypercalcemia

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