Which one of these agents are potential treatment options for sarcoidosis induced hypercalcemia?
In a earlier study in JAMA years ago, it was established that the hypercalcemia in sarcoidosis is 1,25 vitamin d production mediated. Classically, for 1,25 Vitamin D mediated hypercalcemia such as in lymphoma, TB. etc, steroids are the mainstay of treatment. A dose of 15-25mg/day of prednisone is usually effective. Ketoconazole is the next line of treatment for patients who cannot tolerate steroids. Since its an imidazole antifungal that inhibits enzymes in steroid synthesis, it works well. Hydrocholoroquine also causes inhibition of 25(OH), D3 1 alpha hydroxylase and can be used in some patients that have side effects to prior two meds. MTX and Azathioprine can be used to treat systemic disease that might have effect on calcium as well. ACTH has not been studied in this arena. Pamidronate has been used in case reports but the mechanism of hypercalcemia doesn't really support the use of that agent.