Endocrine Abstracts

A 51-year-old lady presented as an emergency with disabling, recurrent hypercalcaemia in July and August, 2015 with a peak corrected calcium of 3.94 mmol/l (normal range 2.2–2.6). She had been diagnosed with a stage 1A endometrial cancer, treated with hysterectomy and bilateral salpingo-oophorectomy in April 2014. Significant pelvic and left groin lymphadenopathy was noted, and was found to be enlarging on surveillance CT of July 2015. She was also found to have a left kidney lesion, biopsy of which in February 2015 showed a low grade neoplasm consistent with a renal oncocytoma.

The initial concern was that her hypercalcaemia was due to malignancy. PTH was appropriately suppressed and a myeloma screen was negative. However, PTH-rp was undetectable and careful review of the histology from the hysterectomy of 2014 revealed abundant non-caseating granulomata in nine lymph nodes resected, but without evidence of malignancy. There was no evidence of pulmonary sarcoidosis on the CT of July 2015. At MDT, it was agreed that there was sufficient evidence to make a diagnosis of pelvic sarcoidosis. This diagnosis was later supported by elevated pre-treatment serum ACE of 113U/l (16-85) and 1,25 OH(2) vitamin D of 253 pmol/l (43–143).

The patient was started on Prednisolone 35 mg daily (0.5 mg/kg). Six weeks later, she was back at work. The serum calcium had fallen into the normal range and a CT scan showed reduction in the size of the pelvic and groin lymph nodes. Over the next five months, Prednisolone was successfully withdrawn, without further elevation of serum calcium.

In the literature, undiagnosed sarcoidosis has been reported to delay the correct staging, prognosis and management of a newly diagnosed cancer. This case illustrates the importance of considering extra-pulmonary sarcoidosis as a cause of hypercalcaemia, especially in the context of concurrent malignancy.