Hypercalcemia in granulomatous disorders: a clinical review

Area of Science:

• Endocrinology
• Nephrology
• Immunology

Background:

• Hypercalcemia is a common complication in granulomatous disorders, affecting calcium metabolism.
• Conditions like sarcoidosis, tuberculosis, fungal infections, berylliosis, and lymphomas are associated with calcium dysregulation.
• Activated macrophages in granulomatous inflammation contribute to abnormal calcitriol (1,25-(OH2)D3) production.

Purpose of the Study:

• To review the mechanisms and consequences of disordered calcium metabolism in granulomatous diseases.
• To highlight the potential renal complications of undetected hypercalcemia and hypercalciuria.
• To discuss therapeutic strategies for managing these metabolic abnormalities.

Main Methods:

• Literature review of granulomatous disorders and calcium metabolism.
• Analysis of the role of 1,25-(OH2)D3 in disease pathogenesis.
• Evaluation of treatment outcomes for hypercalcemia in affected patients.

Main Results:

• About 10% of sarcoidosis patients exhibit hypercalcemia, with hypercalciuria being more prevalent.
• Dysregulated calcitriol production by activated macrophages is the primary cause of metabolic abnormalities.
• Nephrocalcinosis, renal stones, and renal failure are potential consequences of untreated hypercalcemia and hypercalciuria.

Conclusions:

• Corticosteroids are effective in rapidly correcting the metabolic defect associated with hypercalcemia in granulomatous disorders.
• For patients unresponsive to or intolerant of corticosteroids, alternative treatments include chloroquine, hydroxychloroquine, and ketoconazole.
• Management of calcium metabolism disorders is crucial to prevent severe renal complications in granulomatous diseases.