Table 5.

Laboratory and radiological testing along with the management of hypercalcemia associated with sarcoidosis.

Laboratory and radiological tests

Management

24-h urine collection for calcium excretion. Parathyroid Hormone (PTH) and PTH-related peptide (PTHrP) Serum creatinine (and/or cystatin C) Serum calcium and albumin levels should be measured and the ionized calcium calculated. Renal Ultrasound to exclude nephrolithiasis Age appropriate malignancy work up (To rule out hypercalcemia secondary to malignancy)

Hypercalciuria without stone formation—observational approach; often requires no treatment. Close monitoring to prevent renal failure. Treatment options may include corticosteroids and/or diuretics. Hypercalciuria with stone formation—Bisphosphonates or corticosteroids should be considered; shockwave lithotripsy Mild, asymptomatic Hypercalcemia—Encourage fluid intake of >2 l per day and minimize their exposure to sunlight, avoid vitamin D and fish oil supplementation. Moderate hypercalcemia—May consider addition of corticosteroids and/or ketoconazole or hydroxychloroquine. Severe hypercalcemia—act immediately: rehydrate. Treatment options include corticosteroids, calcitonin, loop diuretics, and bisphosphonates (144)