{"id":1801677,"date":"2020-04-16T20:31:00","date_gmt":"2020-04-17T00:31:00","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/?p=1801677"},"modified":"2023-03-16T06:21:35","modified_gmt":"2023-03-16T11:21:35","slug":"hypercalcemia-related-to-granulomatous-disease","status":"publish","type":"post","link":"https:\/\/myendoconsult.com\/learn\/hypercalcemia-related-to-granulomatous-disease\/","title":{"rendered":"Hypercalcemia related to Granulomatous Disease"},"content":{"rendered":"<p><strong>Hypercalcemia<\/strong> 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.<\/p>\n<p>Over 90% of patients with hypercalcemia have either <strong>primary hyperparathyroidism<\/strong> (in the clinic, incidental finding) or <strong>malignancy<\/strong> (hospitalization with hypercalcemic symptoms). Either of infectious or non-infectious origin, <strong>Granulomatous diseases<\/strong> can result in hypercalcemia.<\/p>\n<h2>Mechanisms of hypercalcemia in granulomatous disease<\/h2>\n<p><em>How does sarcoidosis and tuberculosis cause hypercalcemia<\/em><\/p>\n<ul>\n<li>Increased <strong>1\u03b1-hydroxylase<\/strong> activity, decreased degradation of <strong>1,25-OHD3<\/strong> (active vitamin D) , secretion of <strong>PTH-related peptide<\/strong> (PTHrP) and cytokines like <strong>IL-6<\/strong> by granulomatous lesions.<\/li>\n<\/ul>\n<h2>Treatment of hypercalcemia of granulomatous disease<\/h2>\n<ul>\n<li>Treatment includes <strong>glucocorticoids<\/strong> (prednisolone 0.5\u20131 mg\/kg\/day) and specific therapy for the underlying disease.<\/li>\n<li>Glucocorticoids inhibit <strong>1\u03b1-hydroxylase activity<\/strong> and <strong>decrease the secretion of cytokines<\/strong> from the granulomatous lesions<\/li>\n<\/ul>\n<h2>Granulomatous diseases<\/h2>\n\n<table id=\"tablepress-62\" class=\"tablepress tablepress-id-62\">\n<tbody>\n<tr class=\"row-1\">\n\t<td class=\"column-1\">Noninfectious causes<\/td><td class=\"column-2\">Infectious causes<\/td>\n<\/tr>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">Beryllosis<\/td><td class=\"column-2\">Leprosy<\/td>\n<\/tr>\n<tr class=\"row-3\">\n\t<td class=\"column-1\">Crohn's disease<\/td><td class=\"column-2\">Tuberculosis<\/td>\n<\/tr>\n<tr class=\"row-4\">\n\t<td class=\"column-1\">Granulomatosis with polyangiitis<\/td><td class=\"column-2\">Coccidioidomycosis<\/td>\n<\/tr>\n<tr class=\"row-5\">\n\t<td class=\"column-1\">Lymphomas<\/td><td class=\"column-2\">Histoplasmosis<\/td>\n<\/tr>\n<tr class=\"row-6\">\n\t<td class=\"column-1\">Eosinophilic granuloma<\/td><td class=\"column-2\">Pneumocystis carinii pneumonia (HIV\/AIDS)<\/td>\n<\/tr>\n<tr class=\"row-7\">\n\t<td class=\"column-1\">Sarcoidosis<\/td><td class=\"column-2\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-62 from cache -->\n<h2>References<\/h2>\n<p>Lemann J Jr, Gray RW. Calcitriol, calcium, and granulomatous disease. <a href=\"https:\/\/doi.org\/10.1056\/nejm198410253111710\" target=\"_blank\" rel=\"noopener\">N Engl J Med. 1984 Oct 25;311(17):1115-7.\u00a0<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[88],"tags":[],"class_list":["post-1801677","post","type-post","status-publish","format-standard","hentry","category-endocrinology-short-notes","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/1801677","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/comments?post=1801677"}],"version-history":[{"count":47,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/1801677\/revisions"}],"predecessor-version":[{"id":4416088,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/1801677\/revisions\/4416088"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=1801677"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/categories?post=1801677"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/tags?post=1801677"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}