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Review
. 2019 Jan-Dec:16:1479973119878713.
doi: 10.1177/1479973119878713.

Sarcoidosis and calcium homeostasis disturbances-Do we know where we stand?

Łukasz Gwadera  1 , Adam Jerzy Białas  1 , Mikołaj Aleksander Iwański  1 , Paweł Górski  1 , Wojciech Jerzy Piotrowski  1
Affiliations
Review

Sarcoidosis and calcium homeostasis disturbances-Do we know where we stand?

Łukasz Gwadera et al. Chron Respir Dis. 2019 Jan-Dec.

Abstract

The majority of cases involving hypercalcemia in the setting of sarcoidosis are explained by the overproduction of calcitriol by activated macrophages. Vitamin D takes part in the regulation of granuloma formation. However, using vitamin D metabolites to assess the activity of the disease is still problematic, and its usefulness is disputable. In some cases, though, a calcium metabolism disorder could be a valuable tool (i.e. as a marker of extrathoracic sarcoidosis). Although sarcoidosis does not cause a decrease in bone mineral density, increased incidence of vertebral deformities is noted. Despite increasing knowledge about calcium homeostasis disorders in patients with sarcoidosis, there is still a need for clear guidelines regarding calcium and vitamin D supplementation in these patients.

Keywords: 1,25(OH)2D3; 25(OH)D3; Sarcoidosis; calcitriol; calcium; hypercalcemia; hypercalciuria; vitamin D.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Selected aspects of human calcium homeostasis.
Figure 2.
Figure 2.
It is well-known that vitamin D plays a complex and still not fully understood role in regulation of immune system. Part of its actions can be directly connected with formation of granuloma. Some of them are presented here.
Figure 3.
Figure 3.
Process of 1-α-hydroxylation of 25(OH)D3 in macrophages is different from the one taking place in kidneys and is not focused on maintaining calcium and phosphate homeostasis but is dependent on immunological processes. The figure shows possible mechanisms of altered vitamin D metabolism and calcium disturbances in sarcoidosis.
Figure 4.
Figure 4.
Proposed scheme of sarcoidosis-associated hypercalcemia treatment.
See this image and copyright information in PMC

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