Hypercalcemia is defined as a serum calcium level above the reference range. The reference range for serum calcium is based on the data derived from healthy subjects and is dependent on age, vitamin D status, and analytical methods.
Over 90% of patients with hypercalcemia have either primary hyperparathyroidism (in the clinic, incidental finding) or malignancy (hospitalization with hypercalcemic symptoms). Either of infectious or non-infectious origin, Granulomatous diseases can result in hypercalcemia.
Mechanisms of hypercalcemia in granulomatous disease
How does sarcoidosis and tuberculosis cause hypercalcemia
- Increased 1α-hydroxylase activity, decreased degradation of 1,25-OHD3 (active vitamin D) , secretion of PTH-related peptide (PTHrP) and cytokines like IL-6 by granulomatous lesions.
Treatment of hypercalcemia of granulomatous disease
- Treatment includes glucocorticoids (prednisolone 0.5–1 mg/kg/day) and specific therapy for the underlying disease.
- Glucocorticoids inhibit 1α-hydroxylase activity and decrease the secretion of cytokines from the granulomatous lesions
Granulomatous diseases
| Noninfectious causes | Infectious causes |
| Beryllosis | Leprosy |
| Crohn's disease | Tuberculosis |
| Granulomatosis with polyangiitis | Coccidioidomycosis |
| Lymphomas | Histoplasmosis |
| Eosinophilic granuloma | Pneumocystis carinii pneumonia (HIV/AIDS) |
| Sarcoidosis |
References
Lemann J Jr, Gray RW. Calcitriol, calcium, and granulomatous disease. N Engl J Med. 1984 Oct 25;311(17):1115-7.
