Sarcoidosis, with no known cause or cure, produces granulomas that manufacture activated vitamin D, creating increased intestinal absorption of calcium, elevating levels in the blood and urine called hypercalcemia. Granulomas, atypical accumulations of inflamed cells, organize in many organs, particularly the lungs. Treatment for sarcoidosis is available and symptomatically directed, including therapy for hypercalcemia, reducing inflammation, hydration and dietary restrictions.
Diagnosis
Sarcoidosis, diagnosed by exclusion of other diseases, is frequently discovered during yearly physicals. Chest x-rays can reveal the granulomas and skin nodules are visible to the eyes. Symptoms are related to the organs involved and many are asymptomatic. A diagnosis relies on medical history, routine lab testing, a physical exam and possibly, tissue biopsy.
Hypercalcemia
Hypercalcemia, detected with lab testing, occurs as a result of the release of vitamin D, increasing absorption of calcium into the bloodstream. Two prevalent causes of hypercalcemia must be excluded first: hyperparathyroidism from benign tumors and cancer with bone metastasis. Parathyroids, four small glands situated behind the thyroid in your neck, balance calcium and phosphorus in your body. Hypercalcemia symptoms include decreased appetite, increased urine, excess thirst and kidney stones.
Treatment
Therapy, symptom directed, is not always necessary. Symptoms include coughing, shortness of breath and hypercalcemia, which might require hospitalization for treatment. Intravenous fluids for hydration, diuretics to remove calcium, medications to halt bone degradation, steroids countering vitamin D effects and dialysis to remove calcium are all methods to treat sarcoidosis. Hydroxychloroquine successfully treats skin nodules, brain effects and hypercalcemia and methotrexate, and may be used if steroids don't work.
Dietary Restrictions
During hypercalcemia treatment, dietary restrictions and life-style changes might be applied until calcium levels return to normal. Food restrictions can include dairy products, calcium-rich foods such as canned salmon with bones, and oranges. Avoid supplements such as calcium and vitamin D and limit sun exposure.
Groups Affected
Sarcoidosis affects more females than males between 20 years and 50 years of age, and more American blacks and Northern European whites. Health-care providers, grade-school teachers, aircraft servicemen and firefighters are groups reflecting a higher incidence of discovery related to frequent physicals. A potential genetic link exists with a family history of sarcoidosis, according to the National Heart Lung and Blood Institute.
Considerations
A particular syndrome of symptoms is associated with sarcoidosis called Lofgrens syndrome, which includes fever, arthritic symptoms of the ankles and swelling of your lymph nodes. Also included in the syndrome is erythema nodosum, a red rash or reddish-purple nodular bumps primarily on your ankles and shins. Erythema nodosum can cause itching and feel warm and painful to touch.
