title: Sarcoidosis-related hypercalcaemia due to production of parathyroid hormone-related peptide.
abstract: Hypercalcaemia is frequently observed in patients with sarcoidosis. This is classically attributed to ectopic production of 1,25 dihydroxy vitamin D by sarcoid granulomas. We present a case of sarcoidosis-related hypercalcaemia with normal vitamin D levels. In this patient, production of parathyroid hormone-related peptide (PTHrp) was the cause for sarcoidosis-induced hypercalcaemia. As such, plasma PTHrp levels were increased and bone marrow granulomas stained positively for PTHrp expression. Medium-dose prednisolone treatment improved symptoms of sarcoidosis and normalised serum calcium, and PTHrp concentrations. Thus, production of PTHrp may be the cause for hypercalcaemia in some patients with sarcoidosis.
authors.affiliation: Department of Internal Medicine, Kennemer Gasthuis, Haarlem, The Netherlands.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: van Raalte
authors.affiliation: Atal Medial Diagnostic Centers, Hoofddorp, The Netherlands.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Goorden
authors.affiliation: Department of Clinical Chemistry, IJsselland Hospital, Capelle aan den IJssel, The Netherlands.
authors.forename: Evelien A
authors.initials: EA
authors.lastname: Kemper
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Lodewijk A A
authors.initials: LA
authors.lastname: Brosens
authors.affiliation: Department of Internal Medicine, Kennemer Gasthuis, Haarlem, The Netherlands.
authors.forename: Reinier W
authors.initials: RW
authors.lastname: ten Kate
mesh_terms: D000368:Aged; D001853:Bone Marrow / Q000473:pathology*; D006099:Granuloma / Q000150:complications; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood*; D044162:Parathyroid Hormone-Related Protein / Q000097:blood*; D011239:Prednisolone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000150:complications*; D014807:Vitamin D / Q000097:blood*
chemical_list: C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D014807:Vitamin D; D011239:Prednisolone