Calcitriol, Calcium, and Granulomatous Disease

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Abstract
Hypercalcemia is known to occur among patients with several granulomatous diseases, including sarcoidosis,1 tuberculosis,2 berylliosis,3 and coccidioidomycosis.4 Hypercalciuria may occur even more commonly and can contribute to the development of kidney stones. In this issue of the Journal, this list of granulomatous disorders is extended with the report of hypercalcemia, hypercalciuria, and nephrolithiasis in association with granulomatous inflammation induced by silicone that was injected subcutaneously for cosmetic purposes.5 Hypercalcemia in patients with sarcoidosis was shown in 1956 to be accompanied by augmented intestinal calcium absorption, the classic biologic effect of vitamin D.6 Subsequently, elevated serum levels of the active . . .