Qadir Ajaz, Misgar Raiz A, Chhabra Ankit, Sofi Javid A
Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
J Family Med Prim Care. 2025 Jul;14(7):3028-3031. doi: 10.4103/jfmpc.jfmpc_203_25. Epub 2025 Jul 21.
Sarcoidosis is a chronic granulomatous disease affecting various organs and is one of the causes of parathyroid hormone (PTH)-independent hypercalcemia. However, sarcoidosis presenting with severe hypercalcemia is very rare. We present a case with an initial presentation of hypercalcemic crisis (corrected calcium of 16.8 mg/dl) and suppressed iPTH (7.2 pg/ml). Upon thorough evaluation, including biochemical, radiology, and histopathology, of the right inguinal lymph node biopsy, extrapulmonary sarcoidosis was diagnosed. The patient was initiated on glucocorticoid therapy, leading to clinical and biochemical improvement. This case is characterized by hypophosphatemia and inappropriately normal 1,25-dihydroxy vitamin D level, a finding rarely reported in the literature. Hypercalcemia may be due to the overproduction of bone-resorbing cytokines, INF-α, IL-6, IL-1β, and PTHrP.
结节病是一种影响多个器官的慢性肉芽肿性疾病，是甲状旁腺激素（PTH）非依赖性高钙血症的病因之一。然而，表现为严重高钙血症的结节病非常罕见。我们报告一例最初表现为高钙血症危象（校正钙为16.8mg/dl）且iPTH受抑制（7.2pg/ml）的病例。经对右侧腹股沟淋巴结活检进行包括生化、放射学和组织病理学在内的全面评估后，诊断为肺外结节病。患者开始接受糖皮质激素治疗，临床和生化指标均有改善。该病例的特点是低磷血症和1,25 - 二羟维生素D水平异常正常，这一发现鲜有文献报道。高钙血症可能归因于骨吸收细胞因子、INF-α、IL-6、IL-1β和PTHrP的过度产生。
