Endocrine Abstracts

Case history: An eight-year-old white male presented to his General Practitioner with a six-month history of cough and malaise. Blood tests revealed isolated hypercalcaemia (4 mmol/l). He was referred to the Children’s Emergency Department for urgent management. On examination, uveitis and lymphadenopathy were noted. Repeat blood tests confirmed hypercalcaemia. Despite hyperhydration and Furosemide, the serum calcium remained persistently elevated.

Investigations: A chest radiograph revealed widespread bilateral fine nodularity. A high-resolution, non-contrast chest computed tomography scan showed multiple tiny nodular opacities with bilateral patchy areas of ground-glass opacification within the lungs. A lymph node biopsy exhibited granuloma formation and serum angiotensin converting enzyme level was elevated (>120 u/l).

Results and treatment: A diagnosis of Sarcoidosis was made and the child was started on prednisolone for Sarcoidosis-related hypercalcaemia.

Conclusions and discussion: Sarcoidosis is a multi-system disorder characterised by non-caseating granuloma. It has a spectrum of clinical manifestations and is known the ‘great masquerader’. It is often encountered in the second to fourth decades of life and is rare in childhood. Hypercalcaemia and/or hypercalciuria are common endocrine manifestations of Sarcoidosis.

Hypercalcaemia is a recognised endocrine manifestation of Sarcoidosis. Recognition of this rare cause of hypercalcaemia is a challenge for clinicians. Sarcoidosis is rarely seen in childhood, but should be considered in patients presenting with refractory hypercalcaemia. High-dose corticosteroid is the treatment of choice for Sarcoidosis-induced hypercalcaemia.