There are a few complications that can result from ongoing inflammation, including those directly related to the formation of granulomas within endocrine glands. They include:
- Hypercalcaemia (too much calcium in the blood) and Hypercalciuria (too much calcium in urine) – The incidence of hypercalcaemia is estimated to be 10% in sarcoidosis patients, with no association with a specific demographic. The severity depends on many factors, including disease activity, sunlight, and diet variations. Hypercalciuria on the other hand is estimated to be three times more common and seen more often in men than women. If left untreated, elevated levels of calcium in the blood or urine can cause potentially severe complications including bone loss, osteoporosis (week or brittle bones, especially with long-term treatment with steroids), and long-term kidney and pancreas complications. While the mechanism is not fully understood, treatment for high levels of calcium in the blood or urine include corticosteroids (first-line treatment), ketoconazole, chloroquine, hydroxcloroquine, and other drugs, including diuretics. Ongoing monitoring of calcium levels is needed to ensure the condition does not worsen and to ensure any side effects of medications do not cause further complications.
- Suppressed Parathyroid Hormone (PTH) – PTH is released by four small glands in the neck when vitamin D metabolites and low levels of calcium are detected in the blood. It is responsible for controlling the levels of ionized calcium and fluid in the blood. Elevated levels of calcium in the blood blocks the release of PTH. Since sarcoidosis patients commonly have high levels of calcium in the blood and therefore suppressed release of PTH, physicians should be suspicious that their patient also suffers from hyperthyroidism when PTH levels are high.
- Vitamin D Dysregulation – Patients who suffer from sarcoidosis often have elevated levels of vitamin D in their blood, believed to be part of the immune response in the condition. However, there are two forms of vitamin D, the active and inactive forms. In doing routine blood work, many physicians will notice that the levels of the active form of vitamin D are low in sarcoidosis patients. To address this perceived issue, patients are often prescribed a supplement to increase the levels of the active form in their system resulting in kidney stones. In order to appropriately determine if a supplement is needed, the physician needs to run more extensive blood work, measuring both the active and inactive forms of vitamin D. Studies have shown that in the majority of cases, no supplementation is required.
Complications in Sarcoidosis Affecting the Eyes
- Cataract Formation – A well recognized complication of uveitis with an estimated 14-30% of patients affected, cateract occurs either as a result of inflammation or treatment with steroids. In general, cataract surgery is the recommended treatment with good outcomes, provided that inflammation is controlled after surgery and there is no permanent damage due to structural abnormalities or glaucoma.
- Glaucoma – Describing increased pressure within the eyeball due to damage of the optic nerve, this condition can result in gradual loss of sight or total blindness. Treatment with corticosteroids is often to blame. It is recommended that sarcoidosis patients have regular appointment with an ophthalmologist (twice a year) to ensure that sarcoidosis affecting the eye and systemic treatments do not cause complications.