Effects of sarcoid and steroids on angiotensin-converting enzyme

Serum angiotensin-converting enzyme (ACE) has been claimed to be a useful guide in the treatment of pulmonary sarcoidosis. We reviewed the clinical course of 36 patients with sarcoidosis who had ACE levels determined on 2 or more occasions during the course of treatment with prednisone for a total of 55 paired observations. There was a clinical deterioration in 13 instances. Of these 13, there was a rise in ACE level in only 7. There was a clinical improvement in 19 instances. Of these 19, only 12 had a fall in ACE level. There was a negative correlation (r = -0.80) between changes in steroid dose and serum ACE level. Of 23 instances where steroids were increased, there was a fall in ACE level. Thus, ACE levels were not useful for following disease activity in patients during a change in medication.