A Clinical Evaluation of Serum Angiotensin Converting Enzyme in Sarcoidosis

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Abstract
Angiotensin converting enzyme [ACE] was measured in the serum of 52 patients with sarcoidosis, 67 healthy control subjects and 64 patients with pulmonary and non-pulmonary diseases. The patients with sarcoidosis were classified on clinical grounds as having active or inactive disease. In 26 patients with active sarcoidosis not taking corticosteroids, the mean serum ACE was significantly higher than in normal controls (P < 0.001). Seventy-three percent of these patients had elevated serum ACE. Only 2 of 12 (17%) patients with inactive sarcoidosis not taking corticosteroids had elevated serum ACE. Serum ACE was normal in patients taking oral corticosteroids for longer than 2 wk. Eighty percent of patients with active sarcoidosis with radiological evidence of pulmonary parenchymal involvement had an elevated serum ACE compared to 25% in patients with normal chest X-rays and 60% of those with bilateral hilar lymphadenopathy. All sarcoid patients with hypercalcemia had elevated serum ACE; only half of those with normal serum Ca had elevated ACE. In the patients with other thoracic and granulomatous conditions serum ACE was normal or rarely marginally elevated. Serum ACE appears to be of value in the diagnosis of active sarcoidosis.