Hypercalcemia can occur in the context of several granulomatous diseases including: Sarcoidosis, Wegener’s granulomatosis, Silicosis, Berylliosis, Tuberculosis, Fungal granulomas and lymphomas.
WHY? Due to pathological up regulation of the conversion of:
Calcidiol (25-hydroxyvitamin D) —> Calcitriol (1,25-(OH2)D3) via 1-hydroxylase
by activated macrophages within the pulmonary parenchyma and granulomatous inflammation.
- Sharma, OP. Hypercalcemia in granulomatous disorders: a clinical review. Curr Opin Pulm Med. 2000 Sep;6(5):442-7.
- M. Fuss, T. Pepersack, C. Gillet, R. Karmali, J. Corvilain. Calcium and vitamin D metabolism in granulomatous diseases. Clinical Rheumatology. March 1992, Volume 11, Issue 1, pp 28–36.
- Hypercalcaemia secondary to granulomatous disorders- a series. Malik Humayun & Tristan Richardson. Endocrine Abstracts (2012) 28 P18.