1108 ELEVATED SERUM 1, 25-DIHYDROXYVITAMIN D (1, 25OH₂D) LEVELS IN THE HYPERCALCEMIA OF SARCOIDOSIS: CORRECTION BY GLUCOCORTICOID THERAPY

Abstract

It has recently been suggested that the hypercalcemia of pulmonary sarcoidosis could be related to high circulating levels of 1,25OH₂D (Bell et al, JCI 64:218, 1978; Papapoulos et al, Lancet i:627, 1979). However, this hypothesis has not been tested in a child. The evaluation of serum calcium levels of 12.4 to 14.8 mg/dl in a 9-year-old girl revealed a low normal immunoreactive PTH level, hypercalcuria, an abnormal Ca/Cr ratio (0.81) and a creatinine clearance of 20.5 ml/min/1.73 M². Because of hepatomegaly, cutaneous anergy and the presence of native macrophage suppressor activity, a liver biopsy was performed which revealed non-caseating granulomata. Vitamin D metabolite levels were: 25OH-D of 27-45 ng/ml (nl 30±5, SD); 24,25OH₂D of 2.3-2.7 ng/ml (nl 1.7±0.5), and 1,25OH₂D of 91 and 75 pg/ml (nl 42±15). Despite hypercalcemia, 1,250H₂D levels were greater than +2 SD above mean value for age. Prednisone therapy (2 mg/kg/day) lowered serum Ca, urinary Ca/Cr ratio and Ca excretion (388 to 182 mg/day), and Cl_Cr rose to 128 ml/min/1.73 M². Levels of 1,25OH₂D fell to 23 and 28 pg/ml. The finding in this and other adults with sarcoidosis suggests that hypercalcemia and hypercalcuria are related to elevated circulating 1,25OH₂D levels. Serum elevations occur independent of PTH or other vitamin D metabolite levels and 1,25OH₂D overproduction and hypercalcemia in sarcoidosis can be reversed by glucocorticoids.

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