Systemic sarcoidosis with hypercalcaemia, hypothalamic-pituitary dysfunction and thyroid involvement

Abstract

Sarcoidosis is a multisystem granulomatous disorder. The lungs are the principal organs affected, however, extrapulmonary involvement including disorders of the pituitary and thyroid glands has been reported but presentation with multiple endocrine manifestations is rare. We report the case of a 36-year-old African-American woman who presented with hypercalcaemia, abnormal thyroid function studies and secondary amenorrhoea. On workup including laboratory, radiological testing and biopsy she was diagnosed with sarcoidosis with multi-organ involvement. Endocrine manifestations included non-parathyroid hormone mediated hypercalcaemia related to sarcoidosis, thyroid involvement with sarcoidosis and hypothalamic-pituitary involvement with a sellar and suprasellar mass associated with secondary adrenal insufficiency, secondary hypogonadism, growth hormone deficiency and secondary hypothyroidism. We report to the best of our knowledge the first case of simultaneous multiple endocrine manifestations of sarcoidosis that included hypercalcaemia, hypopituitarism and sarcoidosis of the thyroid gland.

Figure 1

MRI of the brain. Sagittal view (A) on initial presentation and (B) after 6 months of treatment with prednisone. Coronal view (C) on initial presentation and (D) after 6 months of treatment with prednisone.

Figure 2

Cytology from fine needle aspiration of the right cervical lymph node. (A) Periodic acid-Schiff stain was negative for any fungal element. (B) Aggregate of macrophages was consistent with granuloma.

Figure 3

Fine needle aspiration from the thyroid nodule showing granulomatous formation with thyroid follicular cells.