Increased 1,25-Dihydroxycholecalciferol as a Cause of Abnormal Calcium Metabolism in Sarcoidosis

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Abstract
The mechanism of abnormal calcium metabolism in sarcoidosis was studied in two patients with hypercalcemia and two patients with normocalcemia. Serum immunoreactive parathyroid hormone levels and urinary cAMP excretion were suppressed in two patients with hypercalcemia. Plasma 25-hydroxycholecalciferol was within the normal range in all patients and showed no significant correlation to serum calcium levels or urinary calcium excretion. However, plasma 1,25-dihydroxycholecalciferol [1,25-(OH)2D3] in the patients with hypercalcemia was inappropriately elevated in spite of the coexistent functional hypoparathyroidism and normophosphatemia. In addition, 1,25-(OH)2D3 showed significant positive correlations with serum calcium concentrations and urinary calcium excretion in patients with hypercalcemia. Prednisolone normalized plasma 1,25-(OH)2D3 levels as well as urinary cAMP excretion and corrected hypercalcemia and hypercalciuria. It is concluded that the increased 1,25-(OH)2D3 of unknown etiology is the most probable cause of the abnormal calcium metabolism in sarcoidosis.

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