Endocrine Abstracts

Hypercalcemia is a relatively common extrapulmonary manifestation of sarcoidosis. Sarcoidosis-associated hypercalcemia is due to the uncontrolled synthesis of 1,25-dihydroxycholecalciferol and increased intestinal absorption of calcium which usually results in a low serum concertation of parathyroid hormone (PTH). High levels of PTH in patients with hypercalcemia secondary to sarcoidosis is usually an indication of co-existent primary hyperparathyroidism. We present a case of a 43-year-old white female with initial presentation of intermitted cough and shortness of breath. Chest X-ray revealed hilar lyphadenapathy which was suggestive of sarcoidosis. Serum angiotensin converting enzyme (ACE) was elevated at 91 ACEU. Sarcoidosis diagnosis was confirmed by excisional biopsy of the left cervical lymph node, histological examination showed numerous non-caseating granulomas. Other systemic involvement was not detected by further investigations. She had hypercalcemia with serum calcium 2.81 mmol/l and phosphate level of 0.81 mmol/l.Treatment with oral prednislone relieved her cough and dyspnea. However, her calcium remained high despite steroid therapy. A 24-h urine calcium and vitamin D level were normal. Her PTH noted to be elevated (range 6.9 and 11 pmol/l) in the presence of high calcium confirming coexisting primary hyperparathyroidism. Sestamibi parathyroid scintigraphy did not localize any parathyroid adenoma. She is arranged to undergo total parathyroidectomy with autotransplantation of one parathyroid gland in her forearm. This case highlights the importance of awareness of the possibility of coexisting primary hyperparathyroidism in patients with sarcoidosis.