Clin Case Rep Int | Volume 4, Issue 1 | Case Series | Open Access

Clinical Features of Iatrogenic Hypercalcemia in Sarcoidosis Patients

Emre Yanardag¹, Cuneyt Tetikkurt^2*, Halil Yanardag³, Muammer Bilir³ and Seza Tetikkurt⁴

¹Department of Immunology, Istanbul University, Turkey ²Department of Pulmonary Medicine, Istanbul University, Turkey ³Department of Internal Medicine, Istanbul University, Turkey ⁴Department of Pathology, Demiroglu Bilim University, Turkey

^*Correspondance to: Cuneyt Tetikkurt 

Abstract

Severe hypercalcemia is extremely rare in clinical practice and usually arises due to hyperparathyroidism and malignancy or paraneoplastic syndrome associated with malignancy. Hypercalcemia develops in approximately 10% of the sarcoidosis patients while it has also been described in patients with other granulomatous diseases such as tuberculosis. This abnormality of calcium metabolism is caused by the dysregulated production of calcitriol by activated macrophages in the granulomatous foci of sarcoidosis. Undetected hypercalcemia may have deleterious sequela in sarcoidosis patients, especially without a previous diagnosis, such as nephrocalcinosis and renal failure. This metabolic defect may be exacerbated by sun exposure, phosphorus or vitamin D intake. We present seven cases of sarcoidosis to define the clinical features of such patients who are prone to develop hypercalcemia induced by vitamin D treatment. While only two of our patients had a previously diagnosed sarcoidosis, it was detected in the others while investigating the cause of hypercalcemia. Given the rarity of hypercalcemia due to sarcoidosis and its crucial consequences, it is an imperative that the clinicians should definitely consider the possibility of sarcoidosis before commencing vitamin D treatment to their patients. The sarcoidosis features of our case series reveal the criteria required for clinicians to suspect a possible sarcoidosis disease antecedently and to determine the diagnosis before iatrogenic hypercalcemia develops.

Keywords:

Sarcoidosis; Hypercalcemia; Vitamin D; Iatrogenic hypercalcemia

Citation:

Yanardag E, Tetikkurt C, Yanardag H, Bilir M, Tetikkurt S. Clinical Features of Iatrogenic Hypercalcemia in Sarcoidosis Patients. Clin Case Rep Int. 2020; 4: 1173.