Endocrine aspects of sarcoidosis: disorders of calcium and vitamin D metabolism
Medical Review (Med. pregled), 2026, 62(1), 12-18.
L. Nikolov1, E. Mekov1, M. Boyanov2, R. Petkov1
1Department of Pulmonary Diseases, Faculty of Medicine, Medical University – Sofia
2Department of Internal Medicine, Faculty of Medicine, Medical University – Sofia
Abstract: Sarcoidosis is a multisystem granulomatous disease of unknown etiology that often affects the lungs and lymph nodes, but can also cause significant metabolic disorders. Sarcoidosis often leads to disturbances in calcium homeostasis due to dysregulated extrarenal production of the active form of vitamin D (calci-triol, 1,25(OH)2D) by granulomatous macrophages. This condition predisposes to hypercalcemia, hypercalciuria, and nephrolithiasis even in the presence of low serum 25(OH)D levels. The incidence of these disorders varies depending on the study population, with hypercalciuria being significantly more common than hypercalcemia. Although vitamin D deficiency is common, supplementation carries a risk of worsening metabolic disorders, especially in patients with active disease or renal failure. Treatment of hypercalcemia includes corticosteroids, hydration, and, if necessary, bisphosphonates or other immunosuppressive agents, and the therapeutic approach must be strictly individualized.
Key words: sarcoidosis, calcium homeostasis, vitamin D, hypercalcemia, hypercalciuria, calcitriol
Address for correspondence: Assoc. Prof., Evgeni Mekov, MD, PhD, e-mail: Evgeni.mekov@gmail.com