Endocrine Abstracts

We believe this is the first case report of anunusual presentation of hypercalcemia due to sarcoidosis mimicking metastatic colon carcinoma. A 68 year old lady with a background history of pancolectomy and neoadjuvant chemotherapy for Duke C1 rectal carcinoma under surveillance, ulcerative colitis, type 2 diabetes mellitus presented to the clinic with hypercalcemia with low parathyroid hormone (PTH) and symptoms of tiredness. Her blood test showed Adj Ca of 2.8 mmol/l, PTH < 2.5 pmol/l, Vitamin D 18 mol/l, ALP 177 U/l. She was commenced on 800 IU of vitamin D, ordered for bone scan, 24 h urine calcium excretion ratio, myeloma screen. Her surveillance CT scan couple of months earlier was reported stable features. She had an acute medical admission with unsteadiness of gait, tiredness and nausea. The adjusted calcium level was reported as 3.6 mmol/l with suppressed PTH. She was resuscitated with intravenous fluids and bisphosphate infusion. A CT scan of abdomen, chest and pelvis was organised that showed wide spread liver lesions suggestive of metastasis, small sclerotic lesion in the pelvis suggestive of bony metastasis, stable appearance of low volume mediastinal lymph nodes and abdominal lymphadenopathy. Her bone scan and myeloma results were reported normal. Her urine results showed raised urine creatinine ratio.Outcome of the Gastrointestinal Multidisciplinary team meeting was to offer liver biopsy to decide on palliative chemotherapy. However the histopathology report confirmed chronic granulomatous disease suggestive of sarcoidosis. Patient showed remarkable improvement on corticosteroid therapy. With the background history of malignancy and convincing radiological findings had undermined the clinical rationale of the possibility of sarcoidosis. This case further reinstates that sarcoidosis should be considered as a differential diagnosis in all clinical settings of hypercalcemia with suppressed parathyroid hormone. A histopathological diagnosis, if appropriate should be considered even in the absence of other classical features suggestive of sarcoidosis.