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CASE REPORT
Sarcoidosis-related hypercalcaemia due to production of parathyroid hormone-related peptide
  1. Daniel H van Raalte1,
  2. Susan M Goorden2,
  3. Evelien A Kemper3,
  4. Lodewijk A A Brosens4,
  5. Reinier W ten Kate1
  1. 1Department of Internal Medicine, Kennemer Gasthuis, Haarlem, The Netherlands
  2. 2Atal Medial Diagnostic Centers, Hoofddorp, The Netherlands
  3. 3Department of Clinical Chemistry, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
  4. 4Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Daniel van Raalte, d.vanraalte{at}vumc.nl

Summary

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.

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