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[Hypercalcemia in sarcoidosis--case report, prevalence, pathophysiology and therapeutic options].
- Source :
-
Therapeutische Umschau. Revue therapeutique [Ther Umsch] 2007 May; Vol. 64 (5), pp. 281-6. - Publication Year :
- 2007
-
Abstract
- Hypercalcemia is a highly prevalent complication of sarcoidosis. A medical history of a patient with sarcoidosis is shown as case report. Depending on the population studied about 2-63% of sarcoidosis patients show hypercalcemia. The major difference in the prevalence of hypercalcemia may be in part due to the undulating course of subacute sarcoidosis, so hypercalcemia may be missed when serum calcium is not frequently measured. Hypercalciuria appears to be twice as prevalent then hypercalcemia and should be looked for in every sarcoidosis patient. Hypercalcemia in sarcoidosis is due to the uncontrolled synthesis of 1,25-dihydroxyvitamin D3 by macrophages. 1,25-dihydroxyvitamin D3 leads to an increased absorption of calcium in the intestine and to an increased resorption of calcium in the bone. Immunoregulatory properties have been ascribed to 1,25-dihydroxyvitamin D3. It is an important inhibitor of interleukin-2 and of interferon-gamma-synthesis, two cytokines that are important in granuloma formation in sarcoidosis. It is thought that 1,25-dihydroxyvitamin D3 counterregulates uncontrolled granuloma formation. Treatment of hypercalcemia depends on the serum level of hypercalcemia and its persistence. Generally sarcoidotic patients should be advised to avoid sun exposition to reduce vitamin D3 synthesis in the skin, to omit fish oils that are rich of vitamin D and to produce more than two liters urine a day by adapting fluid intake. Although severe hypercalcemia seems to be rare, glucocorticosteroid treatment should be started if corrected total calcium level rises beyond 3 mmol/l. If hypercalcemia is symptomatic, treatment should be started even at lower levels. Glucocorticosteroids act by inhibition of the overly 1alpha-hydroxylase activity of macrophages. Alternatively, treatment with chloroquine or ketoconazole can be established. If isolated hypercalciuria without hypercalcemia is present with evidence for recurrent nephrolithiasis, patients can be treated with a thiazide diuretic.
- Subjects :
- Aged
Calcitriol blood
Calcium blood
Cross-Sectional Studies
Dose-Response Relationship, Drug
Female
Fluid Therapy
Humans
Hypercalcemia diagnosis
Hypercalcemia physiopathology
Hypercalciuria diagnosis
Hypercalciuria physiopathology
Hypercalciuria therapy
Kidney Failure, Chronic diagnosis
Kidney Failure, Chronic physiopathology
Kidney Failure, Chronic therapy
Macrophages metabolism
Nephrocalcinosis diagnosis
Nephrocalcinosis physiopathology
Nephrocalcinosis therapy
Parathyroid Hormone blood
Prednisone administration & dosage
Risk Factors
Sarcoidosis diagnosis
Sarcoidosis physiopathology
Vitamin D administration & dosage
Vitamin D analogs & derivatives
Vitamin D blood
Hypercalcemia therapy
Sarcoidosis complications
Subjects
Details
- Language :
- German
- ISSN :
- 0040-5930
- Volume :
- 64
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Therapeutische Umschau. Revue therapeutique
- Publication Type :
- Academic Journal
- Accession number :
- 17685088
- Full Text :
- https://doi.org/10.1024/0040-5930.64.5.281