Abstract
AN EVALUATION of hypercalcemia in a 9-year-old girl revealed a low normal immunoreactive PTH level, cutaneous anergy, and abnormal macrophage suppressor activity. Numerous noncaseating granulomata were seen in a liver biopsy specimen confiming diagnosis of sarcoidosis. The patient had hypercalcemia (serum calcium of 14.8 mg/dl), hypercalcuria ( > 300 mg daily), an abnormal urinary calcium/creatinine ration, and a reduced creatinine clearance. An assay of vitamin D metabolites revealed normal 25(OH)-vitamin D~ and D3 levels, normal 24,25(OH)~-vitamin D, and supranormal 1,25(OH)~-vitamin D (calcitriol) concentrations of 91 and 75 pg/ml (normal 42 + 12 pg/ml; SD). Oral prednisone therapy resulted in lower serum calcitriol concentrations and normalized the abnormalities of calcium metabolism. This is the first case in a child supporting the hypothesis that abnormalities of calcium metabolism in sarcoidosis are related to elevated calcitriol concentrations. Sarcoidosis is infrequent during childhood, but abnormalities of calcium metabolism are found in 30 to 50% of childhood cases? These abnormalities of calcium metabolism are similar to those found in vitamin D intoxication. 2 Subjects with sarcoidosis have increased sensitivity
Published Version
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