Hypercalcemia associated with an elevated 1,25 dihydroxy vitamin D3 level and an elevated angiotensin-converting enzyme level in a patient without evidence of sarcoidosis or malignancy

Abstract

An 85-year-old man who presented with depression and lethargy was found to have hypercalcemia, normal phosphorous, and low-normal intact parathyroid hormone level. Work-up revealed no evidence of a malignant or inflammatory process. However, 24-hour urinary calcium excretion was increased, 1,25 dihydroxy (OH2) vitamin D3 level was elevated, and angiotensin-converting enzyme (ACE) level was twice normal. The patient responded to a trial of steroids and his 1,25-OH2 vitamin D3 and ACE levels decreased to within normal limits. The patient has remained eucalcemic on low-dose steroids.