【medical-news】JCEM：结节病是骨化三醇介导高血糖的常见病因

Context. Hypercalcemia mediated by 1,25-dihydroxy vitamin D (calcitriol) is uncommon, with evidence on etiology limited to small case series or case reports.
Objective. To systematically identify a large series of cases of calcitriol-mediated hypercalcemia, document the presentation, demographics and clinical course across etiologies.
Design, setting and patients. Hospital based, retrospective case series, identifying subjects from 1999–2009 across the public hospital system in Queensland, Australia. All patients aged over 18 years were identified that had persistent hypercalcemia associated with elevated or inappropriately normal calcitriol concentration or elevated serum angiotensin converting enzyme (ACE).
Results. A total of 101 cases were identified. Sarcoidosis was the most common etiology (49%), followed by hematological malignancy (17%), and infections (8%). Etiologies not previously described include squamous cell carcinoma of the tongue, ovarian cystadenocarcinoma and chronic lymphocytic leukemia. Median serum ACE was higher in sarcoid patients compared to all other causes (218 units/L [176–277] versus 155 units/L [110–208], p<0.001), but a level above the normal range did not discriminate well between cases of sarcoidisis and other causes (specificity at cut-off of 130 units/L was only 31%). However, a value greater than 250 units/L was highly specific (89%) for sarcoidosis, but lacked sensitivity (31%). A calcitriol level greater than 300pmol/L was not seen in sarcoidosis, but was with other etiologies. Cases with neoplastic etiologies were older (61.4 ± 11.4 years) than all other subjects (51.7 ± 15.0 years, p=0.006).
Conclusions. Hypercalcemia mediated by calcitriol remains a rare presentation. In almost half the cases, sarcoidosis was the underlying cause, while a third of patients had cancer or systemic infections.