Endocrine Abstracts

We describe two cases of sarcoidosis associated hypercalcaemia, renal failure and anaemia mimicking lymphoma. The diagnosis was made by lymph node biopsy. Within weeks of starting oral steroids, symptoms resolved and biochemical abnormalities almost normalized.

Case 1: A 66-year-old lady, presented with generalized weakness, lymphadenopathy and splenomegaly. Hb 96 g/l, MCV 91, urea 16.6 mmol/l, creatinine 227 umol/l, eGFR 15 ml/min, serum calcium 3.4 mmol/l, PTH suppressed, ACE level 167 IU/l (NR. 8–70). CT abdomen revealed lymphadenopathy and splenomegaly. Bone marrow aspirate and trephine- normal. A lymph node biopsy confirmed the diagnosis of sarcoidosis. Four weeks after commencing prednisolone, Hb 118 g/l, serum calcium 2.36 mmol/l, ACE 66 u/l, urea 12.6 mmol/l, creatinine 112 umol/l, eGFR 46 ml/min.

Case 2: A 33-year-old lady, presented with joint pain, weight loss, generalized lymphadenopathy and splenomegaly. Haemoglobin 8.8 g/l, MCV 76, urea 8.9 mmol/l, creatinine 162 umol/l, eGFR 50 ml/min, serum calcium 3.95 mmol/l, phosphate 1.06 mmol/l, PTH 0.7 pmol/l, ACE 96 u/l. CT abdomen/chest revealed lymphadenopathy and splenomegaly. A lymph node biopsy confirmed the diagnosis. Four weeks after commencing prednisolone, Hb 13.2 g/l, calcium, urea and creatinine- normal, eGFR 65 ml/min. Eight weeks later, a CT chest/abdomen showed regression in lymph node size.

Sarcoidosis may mimic lymphoma with generalised lymphadenopathy and splenomegaly. This may be associated with renal impairment due to granulomatous interstitial disease, glomerular disease, obstructive uropathy and rarely end stage renal disease. Granulomatous interstitial nephritis can be treated effectively with glucocorticoids which should be started promptly.

Sarcoidosis should be considered as a differential diagnosis in any patient with hypercalcaemia and lymphadenopathy. Early lymph node biopsy allows prompt diagnosis and treatment with corticosteroids. Resolution of the clinical syndrome may be very dramatic.