ENHANCED PRODUCTION OF CALCITRIOL, AND HYPERCALCEMIA IN A PATIENT WITH SARCOIDOSIS PROVOKED BY DAILY INTAKE OF CALCIOL

A case of sarcoidosis is described which presented with hypercalcaemia and renal insufficiency. Initially, a calciol intoxication was diagno sed, because a high daily intake was suspected. However, vitamin D3 me tabolites in the blood revealed normal concentrations of calcidiol, bu t extremely high concentrations of calcitriol. These features rejected the first diagnosis and pointed to high endogenous calcitriol product ion, which may take place in granulomatous diseases. This is caused by an increased 1-alpha-hydroxylation reaction in activated macrophages. Eventually, muscle biopsy revealed non-caseating granulomas, confirmi ng the diagnosis of sarcoidosis.