Shinozaki K, Koya D, Sakamoto K, Kashiwagi A, Yamamoto I, Kikkawa R, Shigeta Y
Third Department of Medicine, Shiga University of Medical Science.
Nihon Naibunpi Gakkai Zasshi. 1994 Jun 20;70(5):503-10. doi: 10.1507/endocrine1927.70.5_503.
A 71-year-old man with a history of sarcoidosis was admitted to our hospital because of polyuria and polydipsia. On admission, the serum calcium concentration was elevated to 12.7mg/dl, and the creatinine clearance was 28.3ml/min. The initial serum 1,25-dihydroxyvitamin D concentration was 55.0pg/ml, while angiotensin-converting enzyme activity and serum PTH-rP concentration were within the normal range. Radiological studies revealed enlargement of bilateral hilar lymph nodes and a nodular lesion in the right lower lung field. Transbronchial lung biopsy showed noncaseous granuloma consistent with pulmonary sarcoidosis. After oral administration of 20mg prednisolone daily, the serum calcium and 1,25-dihydroxyvitamin D concentration returned to normal, and creatinine clearance was raised to 55ml/min. In conclusion, low dose glucocorticoid administration successfully reduced serum 1,25-dihydroxyvitamin D level with a prompt decrease in serum calcium level in a patient with sarcoidosis.
一名有结节病病史的71岁男性因多尿和烦渴入住我院。入院时，血清钙浓度升高至12.7mg/dl，肌酐清除率为28.3ml/min。初始血清1,25 - 二羟维生素D浓度为55.0pg/ml，而血管紧张素转换酶活性和血清PTH - rP浓度在正常范围内。影像学检查显示双侧肺门淋巴结肿大及右下肺野有结节状病变。经支气管肺活检显示与肺结节病一致的非干酪样肉芽肿。每日口服20mg泼尼松龙后，血清钙和1,25 - 二羟维生素D浓度恢复正常，肌酐清除率提高至55ml/min。总之，低剂量糖皮质激素给药成功降低了结节病患者的血清1,25 - 二羟维生素D水平，并使血清钙水平迅速下降。
