Calcitriol, Calcium, and Granulomatous Disease

Hypercalcemia is known to occur among patients with several granulomatous diseases, including sarcoidosis, 1 tuberculosis, 2 berylliosis, 3 and coccidioidomycosis. 4 Hypercalciuria may occur even more commonly and can contribute to the development of kidney stones. In this issue of the Journal , this list of granulomatous disorders is extended with the report of hypercalcemia, hypercalciuria, and nephrolithiasis in association with granulomatous inflammation induced by silicone that was injected subcutaneously for cosmetic purposes. 5 Hypercalcemia in patients with sarcoidosis was shown in 1956 to be accompanied by augmented intestinal calcium absorption, the classic biologic effect of vitamin D. 6 Subsequently, elevated serum levels of the active . . .