Baughman R P, Janovcik J, Ray M, Sweiss N, Lower E E
1Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
Sarcoidosis Vasc Diffuse Lung Dis. 2013 Aug 1;30(2):113-20.
Sarcoidosis associated hypercalcemia (SAHC) may be secondary to excessive levels of 1,25-(OH)2 vitamin D3 produced by autonomous 1-alpha-hydroxylase activity within the granulomas. The frequency, treatment, and consequences of hypercalcemia remain unclear.
Two patient cohorts were studied. In Cohort 1, the prevalence of hypercalcemia in 1606 sarcoidosis patients seen during a six year period was analyzed along with treatment and outcome. Cohort 2 consisted of 261 sarcoidosis patients with measured 25-(OH) vitamin D3 and 1,25-(OH) vitamin D3 levels. In forty patients, serial levels of 25-(OH) vitamin D3 and 1,25-(OH) vitamin D3 were measured at least three months apart without change in therapy.
SAHC was identified in 97 of 1606 (6%) of patients studied and additional nine (0.6%) patients had primary hyperparathyroidism. Post treatment follow up was available in 86 SAHC patients. Hypercalcemia improved in >90% of patients, including eight patients treated solely with vitamin D supplement withdrawal. Renal insufficiency, documented in 41 (42%) of SAHC patients, improved with hypercalcemia treatment. In 80% of Cohort 2 patients low 25-(OH) vitamin D3 levels were measured with only one patient having a low 1,25(OH)2 vitamin D3 level. Elevated 1,25(OH)2 vitamin D3 levels, which were measured in 11% of patients, were higher for those with a history of hypercalcemia.
Sarcoidosis associated hypercalcemia, which is often accompanied by renal insufficiency, responds to treatment of sarcoidosis and withdrawal of vitamin D supplementation. Measurement of serum vitamin 1,25(OH)2 vitamin D3 appears to best evaluate vitamin D status in sarcoidosis patients.
结节病相关性高钙血症（SAHC）可能继发于肉芽肿内自主1-α-羟化酶活性产生的过量1,25-(OH)₂维生素D₃。高钙血症的发生率、治疗方法及后果仍不明确。
对两个患者队列进行了研究。在队列1中，分析了6年期间1606例结节病患者高钙血症的患病率以及治疗情况和结局。队列2由261例测定了25-(OH)维生素D₃和1,25-(OH)维生素D₃水平的结节病患者组成。在40例患者中，至少间隔3个月测量25-(OH)维生素D₃和1,25-(OH)维生素D₃的系列水平，且治疗无变化。
在1606例研究患者中有97例（6%）被诊断为SAHC，另外9例（0.6%）患者患有原发性甲状旁腺功能亢进。86例SAHC患者有治疗后的随访资料。超过90%的患者高钙血症得到改善，包括8例仅通过停用维生素D补充剂治疗的患者。41例（42%）SAHC患者记录有肾功能不全，随着高钙血症的治疗而改善。在队列2的80%患者中测定到低25-(OH)维生素D₃水平，只有1例患者1,25(OH)₂维生素D₃水平低。11%的患者测定到1,25(OH)₂维生素D₃水平升高，有高钙血症病史的患者该水平更高。
结节病相关性高钙血症常伴有肾功能不全，对结节病治疗和停用维生素D补充剂有反应。测定血清1,25(OH)₂维生素D₃似乎是评估结节病患者维生素D状态的最佳方法。
