Sarcoidosis of the Thyroid and Kidneys and Calcium Metabolism

Om P. Sharma; Violeta Vucinic

doi:10.1055/s-2002-36521

Seminars in Respiratory and Critical Care Medicine, Inhaltsverzeichnis

Semin Respir Crit Care Med 2002; 23(6): 579-588
DOI: 10.1055/s-2002-36521

Sarcoidosis of the Thyroid and Kidneys and Calcium Metabolism

Om P. Sharma¹ , Violeta Vucinic²

¹Keck School of Medicine, Los Angeles CountyUniversity of Southern California, Los Angeles, California
²University of Belgrade School of Medicine, Belgrade, Yugoslavia

Abstract

ABSTRACT

In sarcoidosis, the thyroid and the kidneys are infrequently affected. Clinically recognizable thyroid involvement occurs in < 1% of sarcoidosis patients. Hyperthyroidism, myxodema, and thyroid occur with an equal frequency. It is important to distinguish sarcoidosis of the thyroid from other infections and disorders of the gland.

Renal involvement may present as granulomatous infiltration of the renal parenchyma, glomerulonephritis, renal arteritis, and nephrocalcinosis or renal stones. The latter are due to abnormalities of calcium metabolism.

Hypercalcemia occurs in about 10 to 13% of sarcoidosis patients; hypercalciuria is three times more frequent. Calcium abnormalities may precede, follow, or occur at any time during the course of sarcoidosis. An endogenous overproduction of 1,25-dihydroxyvitamin D [1,25-(OH₂)-D₃] by granulomatous tissue and activated macrophages results in an increase of intestinal absorption of calcium. Corticosteriods, chloroquine, and hydroxychloroquine subdue 1,25-(OH₂)-D₃ production and correct hypercalcemia and hypercalciuria.

KEYWORD

Granuloma - hypercalcemia - hypercalciuria granulomatous nephritis - sarcoidosis

Volltext

Referenzen

REFERENCES

1 Spencer J, Warren S. Boeck s sarcoid: report of a case with clinical diagnosis confirmed at autopsy. Arch Intern Med . 1938; 62 285-288
2 Mayock R, Bertrand P, Morrison C. Manifestations of sarcoidosis: analysis of 145 patients with a review of nine series from the literature. Am J. Med . 1963; 35 67-89
3 Karlish A, MacGregor G. Sarcoidosis, thyroiditis, and Addisons disease. Lancet . 1970; 2 330-333
4 Vogt H. Morbus Besnier-Boeck Schaumann: Klinsche and pathologische anatomische studie. Helio Med Acta . 1949; 25(suppl) S1-S105
5 Winnacker J, Becker K, Katz S. Endocrine aspects of sarcoidosis. N Engl J Med . 1968; 278 483-492
6 Ricker W, Clark M. Sarcoidosis: A clinico-pathologic review of 300 cases including 22 autopsies. Am J Clin Pathol . 1949; 19 725-749
7 Turiaf J, Marland P, Basset F. La sarcoidose du corps-thyroide, a propos d ll cas de sarcoidose kysteque du corps thryoide. An Med Interne . 1969; 120 838-845
8 Vailati A, Marena C, Aristia L, et al Sarcoidosis of the thyroid: report of a case and review of the literature. Sarcoidosis . 1993; 10 66-68
9 Seinfeld E, Sharma O. The Tass syndrome. Proc Roy Soc Med . 1983; 76 883-885
10 Harach H, Williams E. The pathology of granulomatous diseases of the thyroid gland. Sarcoidosis . 1990; 7 19-27
11 Weisenhutter C, Sharma O. Is sarcoidosis an autoimmune disease?. <~>Report of four cases and review of the literature. Semin Arthr Rheum . 1979; 9 124-160
12 Brun J, Mouriquand C, Combey P. Thryoidite sclereuse d origine sarcoidosique avec myxodeme et fibrose pulomonaire diffuse. Lyon Med . 1959; 201 179-188
13 Buckle R. Sarcoid goitre. Proc Roy Soc Med . 1963; 56 611-612
14 Richards A. Myxodema reflex as presenting sign in sarcoidosis. Can Med Assoc J . 1962; 96 32-34
15 Cowdell R. Sarcoidosis with special reference to diagnosis and prognosis. Q J Med . 1954; 23 29
16 Cummins S, Clark D, Gandy T. Boeck s sarcoid of thyroid gland. Arch Pathol . 1951; 51 68-71
17 Hancock B, Millard L. Sarcoidosis and thyrotoxicosis: a study of five patients. Br J Dis Chest . 1976; 70 129
18 Melman K, Goldberg J. Sarcoidosis and exophthalomos as initial symptom. Am J Med . 1962; 33 158
19 Sharma O, Dostanic D. Unilateral proptosis and pleural effusion due to sarcoidosis. Sarcoidosis . 1995; 12 68-70
20 Capecchi V, Savorani G, Bacchini P. Sarcoidosis of the thyroid gland. Sarcoidosis Vasc Diffuse Lung Dis . 1997; 14 188-192
21 Van Assendelft H W A, Kahlos T. Sarcoidosis of the thyroid gland. Sarcoidosis . 1995; 2 154-156
22 Warshawsky M, Shanies H, Rozo A. Sarcoidosis involving the thyroid and pleura. Sarcoidosis Vasc Diffuse Lung Dis . 1997; 14 165-168
23 Coplu L, Caglar M, Kisacik F. Sarcoidosis with thyroid involvement. Sarcoidosis Vasc Diffuse Lung Dis . 1997; 14 86-87
24 Berger S, Zonszein J, Villanena P. Infectious diseases of the thyroid gland. Rev Infect Dis . 1983; 5 108-122
25 Slavin R, Walsh T, Pollack A. Late generalised tuberculosis: a clinical pathologic analysis and comparison of 100 cases in the preantibiotic and antibiotic eras. Medicine . 1980; 59 332-356
26 Taillandier J, Faux N, Manigand G. Sarcoidosis et hyperthroidie. Sem Hosp (Paris) . 1982; 58 617-620
27 Longcope W, Freiman D. A study of sarcoidosis based on a combined investigation of 160 cases including 30 autopsies from the Johns Hopkins Hospital and MGH. Medicine . 1984; 31 1-37
28 Muther R, McCarron D, Bennett W. Renal manifestations of sarcoidosis. Arch Intern Med . 1998; 141 643-645
29 Hagege A, Baglin J, Prinseau J. Sarcoidosis disclosed by renal insufficiency (3 cases). Sem Hop Paris . 1983; 59 2823-2826
30 Guenel J, Chevet D. Interstitial nephropathies in sarcoidosis: effect of corticosteroid therapy and long-term evolution: retrospective study of 22 cases. . 1988; 9 253-257
31 Tateno S, Kobayashi Y. Renal manifestations of sarcoidosis: a review. Nippon Rinsho (Japanese Journal of Clinical Medicine) . 1994; 52 1613-1618
32 Sheffield E. Pathology of sarcoidosis. Clin Chest Med . 1997; 18 741-754
33 Rizzato G, Colombo P. Nephrolithiasis as a presenting feature of chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis . 1996; 13 167-172
34 Gobel V, Kettritz R, Schneider W. The protean face of renal sarcoidosis. J Am Soc Nephrol . 2001; 12 616-623
35 Utas C, Dogukan A, Patiroghu T. Granulomatous interstitial nephritis in extrapulmonary sarcoidosis. Clin Nephrol . 1999; 51 252-254
36 Schwarz A, Krause P H, Kunzendorf V. The outcome of acute interstitial nephritis: risk factors for the transition from acute to chronic interstitial nephritis. Clin Nephrol . 2000; 154 179-190
37 Schwarz A, Krause P H, Keller F. Granulomatous interstitial nephritis after nonsteroidal anti-inflammatory drugs. Am J Nephrol . 1988; 8 410-416
38 Marie I, Lecomte F, Leveque H. Granulomatous nephritis as the first manifestation of Whipple disease. Ann Intern Med . 2000; 132 94-95
39 Manes M, Molino A, Gaiter A. Isolated renal failure secondary to sarcoidosis. Recenti Progressi in Medicina . 2000; 91 441-443
40 Morimoto T, Watanabe K, Kobashi R. Renal sarcoidosis monitored with gallium scintigraphy: report of a case. Gen Med . 2000; 1 23-27
41 Dimitriades C, Shetty K, Vehaskari M. Membranous nephropathy associated with childhood sarcoidosis. Pediatr Nephrol . 1999; 13 444-447
42 Khan I, Simpson J, Catto G. Membranous nephropathy and granulomatous interstitial nephritis in sarcoidosis. Nephron . 1994; 66 459-461
43 Mundlein E, Greten T, Ritz E. Graves disease and sarcoidosis in a patient with minimal glomerulonephritis. Nephrol Dial Transplant . 1996; 11 860-862
44 Parry R, Falk C. Minimal change disease in association with sarcoidosis. Nephrol Dial Transplant . 1997; 12 2159-2160
45 Quismorio F, Sharma O, Chandor S. Immunopathological studies on the cutaneous lesions in sarcoidosis. Br J Dermatol . 1977; 97 635-642
46 Auinger M, Irsigler K, Breiteneder S. Normocalcemic hepatorenal sarcoidosis with crescentic glomerulonephritis. Nephrol Dial Transplant . 1977; 12 1474-1477
47 Ahuja T, Mattana J, Valerraman E. Wegeners granulomatosis followed by development of sarcoidosis. Am J Kid Dis . 1996; 28 893-898
48 Taylor J, Ansell I. Steroid sensitive nephrotic syndrome and renal impairment in a patient with sarcoidosis. Nephrol Dial Transplant . 1996; 11 355-356
49 Nishiki M, Murakami Y, Yamane Y. Steroid-sensitive nephrotic syndrome, sarcoidosis and thyroiditis: a new syndrome. Nephrol Dial Transplant . 1999; 14 2008-2010
50 Schmidt R, Bender F, Change W. Sarcoidosis after renal transplant. Transplantation . 1999; 68 1420-1423
51 Marinides G, Hajdu I, Gans R. A unique association of renal carcinoma with sarcoid reaction in the kidney. Nephron . 1994; 67 477-480
52 Bottone A, Labarbera M, Asadourian A. Renal sarcoidosis coexisting with hypernephroma. Urology . 1993; 41 157-159
53 Moder K, Litin S, Gaffey T. Renal cell carcinoma associated with sarcoid-like tissue reaction. Mayo Clin Proc . 1990; 65 1498-1501
54 Campbell F, Douglas-Jones A. Sarcoid-like granulomas in primary renal cell carcinoma. Sarcoidosis . 1993; 10 128-131
55 Nuther R, McCarron D, Bennett W. Renal manifestations of sarcoidosis. Arch Intern Med . 1981; 141 643-646
56 Holick M F, Adams J S. Vitamin D metabolism and biological function. In: Aveoli LV, Krans SM, eds. Metabolic Bone Disease Philadelphia: WB Saunders 1990: 155-195
57 Harrell G T, Fisher S. Blood chemical changes in Boecks sarcoid with particular reference to protein, calcium and phosphotase values. J Clin Invest . 1939; 18 687-693
58 Henneman P H, Dempsey E F, Carol E J, Albright F. The causes of hypercalcemia in sarcoidosis and its treatment with cortisone and sodium phytate. J Clin Invest . 1956; 35 1229-1242
59 Taylor R L, Lynch Jr J H, Winsor W G. Seasonal influence of sunlight on the hypercalcemia of sarcoidosis. Am J Med . 1963; 35 67-89
60 Dent C E. Calcium metabolism in sarcoidosis. Postgrad Med J . 1970; 46 471-473
61 Hendrix J Z. The remission of hypercalcemia and hypercalciuria in systemic sarcoidosis by vitamin D depletion. Clin Res . 1963; 11 220-225
62 Adams J. Vitamin D metabolite-mediated hypercalcemia. Endocrinol Metab Clin N Am . 1989; 18 765-778
63 Bell N H, Stern P H, Pantzer E, Sinha T, DeLuca H. Evidence that increased circulating 25-dihydroxy vitamin D is the probable cause for abnormal calcium metabolism in sarcoidosis. J Clin Invest . 1979; 64 218-225
64 Mitchell T H, Stamp T CB, Jenkins J L. Hypercalcemic sarcoidosis in hypoparathyroidism Br Med J . 1983; 1 764-765
65 Zimerman J, Holick M F, Silver J. Normocalcemia in a hypothyroid patient with sarcoidosis: evidence for parathyroid hormone independent synthesis of 1,25-dihydroxy vitamin D. Ann Intern Med . 1983; 98 338
66 Barbour G L, Cobwin J W, Slatopolsky E, Norman A, Horst R. Hypercalcemia in an anephric patient with sarcoidosis: evidence for extrarenal generation of 1,25-dihydroxy vitamin D. N Engl J Med . 1981; 305 440-443
67 Adams J, Sharma O, Gacad M. Metabolism of 25-hydroxy vitamin D3 by cultured pulmonary alveolar macrophages in sarcoidosis. J Clin Invest . 1983; 72 1856-1860
68 Mason R, Frankel T, Chan Y L. Vitamin D conversion by sarcoid lymph node homogenate. Ann Intern Med . 1984; 100 59-61
69 Cadranel J. Vitamin D, endocrine and paracrine mediator in cases of pulmonary granulomatosis. Rev Mal Resp . 1995; 12 119-120
70 Bhalla A K, Amento E P, Clemens T L, Holick M, Krane S. Specific high-affinity receptors for 1,25-dihydroxy vitamin D₃ in human peripheral blood mononuclear cells, presence in monocytes and induction in T lymphocytes following activation. J Clin Endocrinol Metab . 1983; 57 1308-1310
71 Adams J S, Modlin R L, Diz M M, Barnes P. Potentiation of the macrophage 25-hydroxy vitamin D-1 hydroxylation reaction by human pleural effusion fluid. J Clin Endocrinol Metab . 1989; 69 457-460
72 Barnes P F, Modlin R L, Bikle D D, Adams J. Transpleural gradient of 1 25-dihydroxy vitamin D in tuberculous pleuritis. J Clin Invest . 1989; 83 1527-1532
73 Rigby W F, Noelle R J, Krause K, Fanger M W. The effect of 1,25-dihydroxy vitamin D on human T lymphocyte activation and proliferation: a cell cycle analysis. J Immunol . 1985; 135 2279-2286
74 McFadden R G, Vickers K E, Fraher L. Lymphocytes: chemokinetic factors derived from human tonsils: modulation by 1,25-dihydroxyvitamin D3 (calcitriol). Am J Respir Cell Mol Biol . 1991; 4 42-49
75 Haq A U. 1 25-Dihydroxy vitamin D₃ (calcitriol) suppresses IL-2 induced murine thymocyte proliferation. Thymus . 1986; 8 295-306
76 Rigby W, Denome S, Fanger M. Regulation of lymphokine production and human T lymphocyte activation by 1,25-dihydroxy vitamin D3. J Clin Invest . 1987; 79 1659-1664
77 Provvedini D M, Tsoukas C D, Deftos L J, Manolagas S C. 1a,25-Dihyroxyvitamin D₃binding macromolecules in human β-lymphocytes: effects on immunoglobulin production. J Immunol . 1986; 136 2734-2740
78 Sharma O. Hypercalcemia in granulomatous disorders: a clinical review. Cur Opin Pulm Med . 2000; 6 442-447
79 McCort J J, Wood R H, Hamilton J B, Ehrlich D E. Sarcoidosis: a clinical and roentgenographic study of 28 proven cases. Arch Intern Med . 1947; 80 293-321
80 Cummings M M. Epidemiologic and clinical observations in sarcoidosis. Ann Intern Med. . 1959; 50 879-890
81 Scadding J G. The kidney and calcium metabolism in sarcoidosis. In: Scadding JG and Mitchell DN, eds. Sarcoidosis London: Chapman and Hall Medical 1985: 390413
82 Mather G. Calcium metabolism and bone changes in sarcoidosis. Br Med J . 1957; 1 248-253
83 Putkonen T, Hannuksela N, Hahme H. Calcium and phosphorus metabolism in sarcoidosis. Acta Med Scand . 1965; 177 327-335
84 James D G, Neville E, Siltzbach L E. A worldwide review of sarcoidosis. Ann NY Acad Sci . 1976; 278 321-334
85 Cronin C C, Dimnear S F, O Mahony, et al. Precipitation of hypercalcemia in sarcoidosis by foreign sun holidays: report of four cases. Postgrad Med J . 1990; 66 307-309
86 Webb A R, Kline L W, Holick W F. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D₃ synthesis in human skin. J Clin Endocrinol Metab . 1988; 67 377-378
87 Mundy G, Raisz L, Cooper R, Schechter G, Salmon S. Evidence for the secretion of an osteoclast stimulating factor in myeloma. N Engl J Med . 1974; 291 1041-1046
88 Broulik P, Votava V, Pacovsky V. The tubular maximun for calcium reabsorption in patients with chronic active thoracic sarcoidosis. Eur Respir J . 1990; 3 447-449
89 Sharma O P. Vitamin D, calcium and sarcoidosis. Chest . 1996; 109 535-539
90 Adams J S, Diz M M, Sharma O P. Effective reduction in the serum 1,25- dihydroxy vitamin D and calcium concentration in Sarcoidosis: associated hypercalcemia with short course chloroquine therapy. Ann Int Med . 1989; 111 437-438
91 Barr-é P E, Gascon-Barr M, Meakins J, Goltzman D. Hydroxychloroquine treatment of hypercalcemia in a patient with sarcoidosis undergoing hemodialysis. Am J Med . 1987; 82 1259-1262
92 O Leary J T, Jones G, Yip A, Lohnes D, Cohanim M, Yendt E R. The effects of chloroquine on serum 1,25-dihydroxy vitamin D and calcium metabolism in sarcoidosis. N Engl J Med . 1986; 315 727-730
93 Adams J, Sharma O, Diz M, Endres D. Ketoconazole decreases the serum 1,25-dihydroxy vitamin D and calcium concentration in sarcoidosis associated hypercalcemia. J Clin Endocrinol Metab . 1990; 70 1090-1095
94 Ejaz A A, Zabaneh R I, Tiwari P, Nawab Z M, Leehey D J, Ing T S. Ketoconazole in the treatment of recurrent nephrolithiasis associated with sarcoidosis. Nephrol Dial Transplant . 1994; 9 1492-1494
95 Sharma O, Alfaro C. Hypercalciuria and renal stones in sarcoidosis patient treated by extracorporal shockwave lithotripsy. Sarcoidosis . 1986; 3 7-9