Relationship between sarcoidosis and hypercalcemia

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rajamohan82@gmail.com - 09 Jun 2006 15:24 GMT

This is a short question, but I am wondering why there is hypercalcemia
in patients with sarcoidosis? What is the underlying physiological
mechanism? Thanks.

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Robert CLS, MT(ASCP) - 09 Jun 2006 19:07 GMT

> This is a short question, but I am wondering why there is hypercalcemia
> in patients with sarcoidosis? What is the underlying physiological
> mechanism? Thanks.

Sarcoidosis is a general immune activation as seen by elevated
angiotension converting enzyme levels and Tcell subset alternations
with resultant granulomatous formation.
In the liver they can act as a space occupying lesion with markers of
cholestasis being present.

In the lungs with Bronchial-lavage samples yielding lymphocytosis and
subset alternations.

"In vitro experiments of cultured alveolar macrophages from patients
with sarcoidosis and of homogenized sarcoid lymph node tissue have
demonstrated that the sarcoid macrophage is able to synthesize
1,25-dihydroxyvitamin D via 25-hydroxyvitamin D3-1-alpha hydroxylating
activity. The excess circulating 1,25-dihydroxyvitamin D produced
extrarenally causes increased intestinal absorption of calcium,
enhanced bone resorption, and resultant hypercalciuria with or without
hypercalcemia."

http://www.emedicine.com/PED/topic2043.htm

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Pete - 09 Jun 2006 21:57 GMT

Thanks Robert...I have sarcoidosis (along with a whole shitload of other
problems), diagnosed in 1992 (pathology via Thoracoscopy revealed extensive
fibrosis in lungs). I was the forth person (where I lived at the time) to
get the new video assisted surgery with the new cutter/stapler. Much better
than the old method (thoracotomy) which was equivalent to open heart
surgery, but I was still in hospital five days at the time (no picnic).

I also have a serious T-4 cell deficiency not discovered until 2002 (my
counts are normally below 200 - non hiv, cause unknown - and I had the rna
by pcr to rule out hiv, in addition to the standard elisa tests, and the hiv
type 2 test - and I am not a homosexual). I can get no help from anyone
(including infectious disease doc, and oncologist/hematologist, and
pulmonologist) on finding the cause of my T-4 cell deficiency, and have
studied the human immune system at length (black magic as you know).

It is interesting that the site you mentioned talks about the possibility of
sarcoidosis affecting the bone marrow, but none of the a.shole doctors I
have gone to offered that as a possible cause of my T-4 cell deficiency. I
also have enlarged lymph nodes in the retrocrural area of my chest and in
way of one of my kidneys.

I gave up on studying sarcoid years ago since it is another one of those
cause unknown type diseases, which is low on the research totem pole. I
definitely believe it could be related to the auto immune disorder family,
and I think it could be related to my T-4 cell deficiency also (which I
could have had for a long time, but it was not picked up until I had a CD4
count in 2002).

I have CD4 counts regularly, as well as comprehensive panel and CBC. Just
got my tests back yesterday and my T-4 count was a whopping 206 :-) . My
helper/suppressor ratio is always considerably above 1.0 which is the only
good sign. sh.t, people with AIDS have higher T-4 cell counts than me
(after they take all their bug juice). I always say, wouldn't it be nice if
they could just bottle the little buggers (helper cells), and you could take
them like vitamins :-) .

Just thought I would acknowledge your post, and maybe provide some info for
whoever might be interested. Take care...Pete

>> This is a short question, but I am wondering why there is
>> hypercalcemia in patients with sarcoidosis? What is the underlying
[quoted text clipped - 19 lines]
>
> http://www.emedicine.com/PED/topic2043.htm

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Robert CLS, MT(ASCP) - 09 Jun 2006 23:40 GMT

> It is interesting that the site you mentioned talks about the possibility of
> sarcoidosis affecting the bone marrow, but none of the a.shole doctors I
> have gone to offered that as a possible cause of my T-4 cell deficiency. I
> also have enlarged lymph nodes in the retrocrural area of my chest and in
> way of one of my kidneys.

Hi Pete, sorry about you complicated health problems.

When they mean that any organ can be affected by sarcoid they mean that
any organ can have a granuloma that may or may not impact on organ
function. These are non-caseating granulomas. Obviously with an
increase in space occupying lesion in the bone marrow the counts might
be affected via what they call a myelo replacement and possible
extramedullary blood formation may result in an effort to compensate.
The stem cell lyphocytes are produced in the bone marrow and are
converted into T cells by the thymus. DiGeroge syndrome patients don't
have one or only a partial one and die at an early age due to lack of
immunity.

My understandings and I really haven't looked into it any further than
that but granulomatous formation is unusual in HIV patients as they
have lowered immunity. They often yield TB skin test negative and
candida control negative skin testing and rare to have an allegeric
hypersensitivity pleuritis. Sarcoidosis is somewhat the opposite as
they are immunologically quite active with such granulomas causing
problems in organs.

> I gave up on studying sarcoid years ago since it is another one of those
> cause unknown type diseases, which is low on the research totem pole.

Same here and for the same reason as one ends with speculation only at
this point.

> definitely believe it could be related to the auto immune disorder family,

There is hard evidence for that but the antigen remains elusive.

> and I think it could be related to my T-4 cell deficiency also (which I
> could have had for a long time, but it was not picked up until I had a CD4
> count in 2002).

I don't know that much about sarcoidosis to say if immune burn out is
possible with declining counts.

> I have CD4 counts regularly, as well as comprehensive panel and CBC. Just
> got my tests back yesterday and my T-4 count was a whopping 206 :-) . My
[quoted text clipped - 3 lines]
> they could just bottle the little buggers (helper cells), and you could take
> them like vitamins :-) .

I perform CD4 counts. Your ratio is above 1.0 indicating you have low
lymphocytes counts in general, lymphopenia. HIV patients often have low
CD4 counts and normal CD8 counts and thus normal total lymphs with a
low ratio. You have swollen lymph nodes and just out of curiosity have
they taken any out and looked at one?
Granulomatous formation involves an intact immune response that most
HIV patients lack.

Good luck

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Pete - 10 Jun 2006 01:16 GMT

>> It is interesting that the site you mentioned talks about the
>> possibility of sarcoidosis affecting the bone marrow, but none of
[quoted text clipped - 22 lines]
> they are immunologically quite active with such granulomas causing
> problems in organs.

Thanks Robert...I am very familiar with everything you talk about. It is my
understanding that the Thymus function fades out as you get older, and I
ruled out DiGeorge Syndrome right away (as I wouldn't be alive now), and had
to laugh when the oncologist/hematologist mentioned that it (DiGeorge) was
all she could come up with after checking (duh! - I had already studied all
that sh.t before I went to her - and knew I didn't have DiGeorge Syndrome).

I did have a candida and mumps skin test (with the control as the third
prick) and my immune system is working (ie my body remembered the mumps and
the candida and tested positive to both), which is a good sign :-) . It's
just that I think it is working in a very half a.s way, ie a T-4 cell count
of 200 is not good as you know, and the helper cells are very important in
their monitoring roles. I believe this is partially why I have had some of
the problems I have had in my life (which include a lot of undefined
malaise) and a general feeling of being ill (which is the basic definition
of malaise).

What also bothers me (and there isn't a damn thing I can do about it), is
the Cellular immune system (T cells) is purported to ward off or fight
against tumor cells, in addition to fighting viruses and some bacteria.
Therefore I feel I am at a higher risk for getting cancer. The Humoral
immune system (the B cells) is more to fight bacteria and some viruses, and
I don't have a whole lot of B cells either, but I at least they are above
the low end of the range...Pete

>> I gave up on studying sarcoid years ago since it is another one of
>> those cause unknown type diseases, which is low on the research
[quoted text clipped - 14 lines]
> I don't know that much about sarcoidosis to say if immune burn out is
> possible with declining counts.

Robert...I don't quite follow you here. I believe Sarcoid tends to burn
itself out with time. What do you mean by "immune burn out with declining
counts"...Pete

>> I have CD4 counts regularly, as well as comprehensive panel and CBC.
>> Just got my tests back yesterday and my T-4 count was a whopping 206
[quoted text clipped - 11 lines]
> Granulomatous formation involves an intact immune response that most
> HIV patients lack.

Robert...I have reported before that I don't like doctors and have had many
bad experiences with them, so I will make this quick (I believe you will
remember me in the future). I could not get anyone to show me the damn
lymph nodes and I have the disc from the catscans (they also showed up on an
MRCP). And the damn radiologists (I met with the head guy to show them to
me but all he did was repeat the friggen report to me, and said he checked
the scans and he agreed with the report- but the son of a bitch wouldn't
take the time to show them to me - boy that pisses me off).

To answer your question, I have not had any biopsies of the large nodes (and
they are in difficult areas to get to also and I would be hard pressed to
agree to the risk, along with the damn radiation from fluorescing you),
since the last cat scan (2004) said no change since 2002, which is good,
since apparently they are not growing. However the friggen radiologist in
2002 wrote no "significant adenopathy", so obviously he was remiss,
especially since the largest one in the retrocrural area is purported to be
about 2.5 cm, which is about an inch, and the size of a damn golf ball.

This is just a small example of why I don't like doctors. I have been
abused by doctors, and had my blood lost in a hospital that was supposed to
be sent out, and I have had scans misread, and I can prove it by the
conflicting reports. BTW, when I told the head radiologist about the doc
apparently misreading my 2002 scan (when he said no adenopathy), he had
nothing to say - and conveniently that radiologist moved to another city.

Thanks for your time Robert. I always enjoy your posts, and appreciate your
efforts in the group, like I have told you before...Pete

> Good luck

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