The treatment of hypercalcemia secondary to sarcoidosis involves a combination of managing the underlying sarcoidosis and addressing the hypercalcemia itself.
Management of sarcoidosis
- Corticosteroids: Corticosteroids are the first-line treatment for sarcoidosis, particularly in patients with progressive disease, significant symptoms, or extrapulmonary disease requiring treatment . They are also recommended for patients with major involvement from pulmonary sarcoidosis at higher risk of future mortality or permanent disability . In cardiac sarcoidosis, corticosteroids (with or without other immunosuppressive agents) are recommended for patients with evidence of functional cardiac abnormalities
- Methotrexate: Methotrexate is recommended as a second-line therapy for high-risk patients with continued disease despite corticosteroids or patients unable to tolerate ongoing corticosteroid therapy . It is also considered for patients with symptomatic pulmonary sarcoidosis at higher risk of future mortality or permanent disability treated with corticosteroids and have continued disease or experienced unacceptable side effects from corticosteroids
Management of hypercalcemia
- Intravenous fluids: Adequate hydration with IV fluids is recommended as first-line therapy while awaiting the effect of antiresorptive drugs
- Antiresorptive therapies: Treatment with an IV bisphosphonate or denosumab is recommended. In severe cases (serum calcium > 14 mg/dL; 3.5 mmol/L), a combination of calcitonin and an IV bisphosphonate or denosumab may be initiated
- Calcitonin: Calcitonin can be used for the treatment of hypercalcemia in adults
In conclusion, the treatment of hypercalcemia secondary to sarcoidosis involves managing the underlying sarcoidosis with corticosteroids and/or methotrexate, and addressing the hypercalcemia with intravenous fluids, antiresorptive therapies, and calcitonin. The specific treatment plan should be tailored to the individual patient's clinical presentation and response to therapy.