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Systemic sarcoidosis presenting with hypercalcemia, sinusitis and hypothalamic-pituitary dysfunction.
Anna Vander Heyde1, Carl Gysbrechts2, Anne-Marie Van der Biest3
1Department of General Internal Medicine, University of Ghent, Ghent, Belgium.
Acta Clinica Belgica
|June 27, 2024
Summary
This case highlights a rare presentation of systemic sarcoidosis affecting multiple organs, including the pituitary gland and sinuses. Early diagnosis of extrapulmonary sarcoidosis is crucial for effective management.
Area of Science:
- Endocrinology
- Pulmonology
- Rheumatology
Background:
- Sarcoidosis is a multisystem granulomatous disease of unknown etiology, often affecting the lungs but capable of impacting any organ system.
- While sinus and endocrine dysfunctions are recognized complications, they are infrequently associated with sarcoidosis.
Observation:
- A young Caucasian male presented with persistent sinusitis, erectile dysfunction, anorexia, fever, emaciation, polyuria, and polydipsia.
- Initial investigations revealed hypercalcemia and abnormal thyroid function, prompting further diagnostic workup.
Findings:
- Pulmonary sarcoidosis was diagnosed, with corticosteroid treatment leading to symptom resolution in sinusitis and normalization of calcemia and thyroid function.
- However, impotence, polydipsia, and polyuria persisted, indicating extrapulmonary involvement, specifically hypothalamic-pituitary axis dysfunction with hypogonadotropic hypogonadism and diabetes insipidus due to a sellar mass.
Implications:
- This case underscores the potential for sarcoidosis to manifest with diverse extrapulmonary symptoms, including pituitary and sinus involvement.
- The diagnostic challenges associated with extrapulmonary sarcoidosis emphasize the need for comprehensive evaluation in complex cases.
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