The Response of Hypercalcemia in Sarcoidosis to Chloroquine
Authors: BARBARA J. HUNT
Journal: Annals of Internal Medicine (1963)

Case Studies1 October 1963The Response of Hypercalcemia in Sarcoidosis to ChloroquineBARBARA J. HUNT, M.B., CH.B., EDMUND REINHOLD YENDT, M.D., F.R.C.P.BARBARA J. HUNT, M.B., CH.B., EDMUND REINHOLD YENDT, M.D., F.R.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-59-4-554 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHypercalcemia occurs in sarcoidosis in 10 to 30 per cent of the cases (1-3). Its recognition and treatment are important because, if uncontrolled, it may lead to nephrocalcinosis, renal lithiasis, and irreversible renal failure (4, 5). The effects of the hypercalcemia per se also require prompt, effective treatment, as symptoms such as nocturia, frequency, persistent nausea and vomiting, muscular weakness and irritability, may cause more incapacity and distress to the patient than the sarcoid process itself.For the last 10 years, cortisone has been the treatment of choice in the hypercalcemia of sarcoidosis (4, 6-8). Its administration rapidly restores calcium...References1. HARRELLFISHER GTS: Blood chemical changes in Boeck's sarcoid with particular reference to protein, calcium and phosphatase values. J. Clin. Invest. 18: 687, 1939. CrossrefMedlineGoogle Scholar2. JACKSONDANCASTOR WPC: A consideration of the hypercalciuria in sarcoidosis, idiopathic hypercalciuria, and that produced by vitamin D; a new suggestion regarding calcium metabolism. J. Clin. Endocr. 19: 658, 1959. CrossrefGoogle Scholar3. MATHER G: Calcium metabolism and bone changes in sarcoidosis. Brit. Med. J. 1: 248, 1957. CrossrefMedlineGoogle Scholar4. SCHOLZKEATING DAFR: Renal insufficiency, renal calculi and nephrocalcinosis in sarcoidosis: report of 8 cases. Amer. J. Med. 21: 75, 1956. CrossrefMedlineGoogle Scholar5. LOFGRENSNELLMANLINDGREN SBAG: Renal complications in sarcoidosis: functional and biopsy studies. Acta Med. Scand. 159: 295, 1957. CrossrefMedlineGoogle Scholar6. SHULMANSCHOENRICHHARVEY LEEHAM: Effects of adrenocorticotropic hormone (ACTH) and cortisone on sarcoidosis. Bull. Hopkins Hosp. 91: 371, 1952. MedlineGoogle Scholar7. DENTFLYNNNABARRO CEFVJD: Hypercalcaemia and impairment of renal function in generalized sarcoidosis. Brit. Med. J. 2: 808, 1953. CrossrefMedlineGoogle Scholar8. PHILLIPSFITZPATRICK RVDP: Steroid therapy of hypercalcemia and renal insufficiency in sarcoidosis. New Eng. J. Med. 254: 1216, 1956. CrossrefMedlineGoogle Scholar9. SODERSTROM N: Two cases of sarcoidosis treated with mepacrine. Lancet 2: 947, 1960. CrossrefGoogle Scholar10. FULD H: Sarcoidosis treated with chloroquine. Letter to the editor. Lancet 2: 1029, 1960. CrossrefGoogle Scholar11. MORSECOHNHIRSCHSCHAEDLER SIZAJGRW: The treatment of sarcoidosis with chloroquine. Amer. J. Med. 30: 779, 1961. CrossrefMedlineGoogle Scholar12. CAMPBELL WR: The estimation of calcium and magnesium. Canad. J. Biochem. 35: 1033, 1957. CrossrefMedlineGoogle Scholar13. GOMORI G: Modification of colorimetric phosphorus determination for use with photoelectric colorimeter. J. Lab. Clin. Med. 27: 955, 1942. Google Scholar14. NATELSONLUGOVOYPINCUS SJKJB: Determination of micro quantities of citric acid in biological fluids. J. Biol. Chem. 170: 597, 1947. CrossrefGoogle Scholar15. FOLINWU OM: System of blood analysis. J. Biol. Chem. 38: 81, 1919. CrossrefGoogle Scholar16. PETERS JH: Determination of creatinine and creatine in blood and urine with photoelectric colorimeter. J. Biol. Chem. 146: 179, 1942. CrossrefGoogle Scholar17. GILLBARTTER JRFC: On the impairment of renal concentrating ability in prolonged hypercalcemia and hypercalciuria in man. J. Clin. Invest. 40: 716, 1961. CrossrefMedlineGoogle Scholar18. HOWARD JE: Hypercalcaemia and renal injury. Ann Intern. Med. Editorial. 16: 176, 1942. LinkGoogle Scholar19. ANDERSONDENTHARPERPHILPOT JCECGR: Effect of cortisone on calcium metabolism in sarcoidosis with hypercalcaemia: possible antagonistic actions of cortisone and vitamin D. Lancet 2: 720, 1954. CrossrefGoogle Scholar20. HENNEMANDEMPSEYCARROLLALBRIGHT PHEFELF: Cause of hypercalciuria in sarcoid and its treatment with cortisone and sodium phytate. J. Clin. Invest. 35: 1229, 1956. CrossrefMedlineGoogle Scholar21. BERLINEREARLEBAUMANSCUDDERSHANNONZUBRODWELCHCONANTAGGART RWDPESTJACGWJNJJV: Studies on Chemotherapy of human malarias: physiological disposition, antimalarial activity and toxicity of several derivative of 4-aminoquinoline. J. Clin. Invest. 27: 98, 1948. CrossrefGoogle Scholar22. LOEBCLARKCOATINGCOGGESHALLDIENAIDEDOCHEZHAKANSSONMARSHALLMANUELMELOYSAPAROSEBRELLSHANNONCARDEN RFWMGRLTFRAREGEKCSJRJJWMJAGA: Activity of new antimalarial agent chloroquine (SN-7618): statement approved by Board for Coordination of Malarial Studies. JAMA 130: 1069, 1946. CrossrefMedlineGoogle Scholar23. BAGNALL AW: The value of chloroquine in rheumatoid disease: a four-year study of continuous therapy. Canad. Med. Ass. J. 77: 182, 1957. MedlineGoogle Scholar24. CALKINSCOHENSHORT EASCL: Longterm chloroquine therapy in rheumatoid arthritis. Med. Clin. N. Amer. 45: 1219, 1961. CrossrefMedlineGoogle Scholar25. MCCHESNEYNACHODTAINTER EWFCML: Rationale for the treatment of lupus erythematosus with antimalarials. J. Invest. Derm. 29: 97, 1957. CrossrefMedlineGoogle Scholar26. CAHNLEVYSHAFFER MMEJB: Polymorphus light eruption: effect of chloroquine phosphate in modifying reactions to ultraviolet light. J. Invest. Derm. 26: 201, 1956. CrossrefMedlineGoogle Scholar27. SHAFFERCAHNLEVY BMMEJ: Sarcoidosis apparently cured by quinacrine (Atabrine) hydrochloride. Arch. Derm. 67: 640, 1953. Google Scholar28. KLAUDER JV: Sarcoid of the eyelids, conjunctiva anduveal tract treated with quinacrine hydrochloride (atabrine dihydrochloride). Arch. Derm. 68: 474, 1953. Google Scholar29. KUNKELSIMONFUDENBERG MGHJMM: Observations concerning positive serological reactions for rheumatoid factor in certain patients with sarcoidosis and other hyperglobulinaemic states. Arthritis Rheum. 1: 289, 1958. CrossrefMedlineGoogle Scholar30. ALVINGEICHELBURGERCRAIGEJONESWHORTONPULLMAN ASLBRCMTN: Studies in the chronic toxicity of chloroquine (SN-7618). J. Clin. Invest. 27, 60, 1948. CrossrefGoogle Scholar31. HOBBSEADIESOMERVILLE HESPF: Ocular lesions after treatment with chloroquine. Brit. J. Ophthal. 45: 284, 1961. CrossrefMedlineGoogle Scholar32. Editorial: Ocular complications of treatment with chloroquine and related antimalarial drugs. Canad. Med. Ass. J. 88: 530, 1963. MedlineGoogle Scholar33. LONGCOPEFREIMAN WTDG: Study of sarcoidosis based on combined investigation of 160 cases including 30 autopsies from Johns Hopkins Hospital and Massachusetts General Hospital. Medicine 31: 1, 1952. CrossrefMedlineGoogle Scholar34. HOLTOWENS JFWK: Osseous lesions of sarcoidosis. Radiology 53: 11, 1949. CrossrefMedlineGoogle Scholar35. HENNEMANCARROLLDEMPSEY PHELEF: Mechanism responsible for hypercalcaemia in sarcoid. J. Clin. Invest. 33: 941, 1954. Google Scholar36. CONNORHOPKINSTHOMASCAREYHOWARD TBTRWCRAJE: Use of cortisone and ACTH in hypercalcemic states. J. Clin. Endocr. 16: 945, 1956. Google Scholar37. VERNERENGELMCPHERSON JVFLHT: Vitamin D intoxication: report of two cases treated with cortisone. Ann. Intern. Med. 48: 765, 1958. LinkGoogle Scholar38. SMITHBLIZZARDHARRISON DWRMHE: Idiopathic hypercalcemia, a case report with assays of vitamin D in the serum. Pediatrics 24: 258, 1959. MedlineGoogle Scholar39. FELLERSSCHWARZ FXR: Etiology of severe form of idiopathic hypercalcemia of infancy: a defect in vitamin D metabolism. New Eng. J. Med. 259: 1050, 1958. CrossrefMedlineGoogle Scholar40. THOMASCONNORMORGAN WCTBHG: Some observations on patients with hypercalcemia exemplifying problems in differential diagnosis, especially in hyperparathyroidism. J. Lab. Clin. Med. 52: 11, 1958. MedlineGoogle Scholar41. THOMASCONNORMORGAN WCTBHG: Diagnostic considerations in hypercalemia with a discussion of the various means by which such a state may develop. N. Eng. J. Med. 260: 591, 1959. CrossrefMedlineGoogle Scholar42. THOMASMORGANCONNORHADDOCKBILLSHOWARD WCHGTBLCEJE: Studies of antiricket activity in sera from patients with disorders of calcium metabolism and preliminary observations on mode of transport of vitamin D in human serum. J. Clin. Invest. 38: 1078, 1959. CrossrefMedlineGoogle Scholar43. THOMASMORGAN WCHG: The effect of cortisone in experimental hypervitaminosis D. Endocrinology 63: 57, 1958. CrossrefMedlineGoogle Scholar44. WILSONCAREANDERSON GADCK: The effect of cortisone on vitamin D2 induced nephrocalcinosis in the rat. Clin. Sci. 16: 181, 1957. MedlineGoogle Scholar45. CRUICKSHANKKODICEK EME: The antagonism between cortisone and vitamin D. Experiments on hypervitaminosis D in rats. J. Endocr. 17: 35, 1958. CrossrefMedlineGoogle Scholar46. JACKSONDANCASTER WPCP: Observations on the effects of vitamin D in man, including the relation to cortisone. J. Clin. Endocr. 22: 195, 1962. CrossrefGoogle Scholar47. NICOLAYSONEEG-LARSEN RN: In bone structure and metabolism. CIBA Foundation Symposium, edited by G. E. W. Wolstenhome and C. M. O'Connor. Little, Brown and Co., Boston, Massachusetts, 1956, p. 175. Google Scholar48. CARLSSONLINDQUIST AB: Comparison of intestinal and skeletal effects of vitamin D in relation to dosage. Acta Physiol. Scand. 35: 53, 1955. CrossrefMedlineGoogle Scholar49. MCJUNKINTWEEDYMCNAMARA FAWREW: Effect of parathyroid extract and calciferol on tissues of nephrectomized rat. Amer. J. Path. 13: 325, 1937. MedlineGoogle Scholar50. ANNINGDAWSONDOLBYINGRAM STJDEJT: Toxic effects of calciferol. Quart. J. Med. 17: 203, 1948. MedlineGoogle Scholar51. ALBRIGHTRIEFENSTEIN FAEC: Parathyroid Glands and Metabolic Bone Disease. Williams and Wilkins, Baltimore, Maryland, 1948. Google Scholar52. FANCONI G: In bone structure and metabolism, CIBA Foundation Symposium, edited by G. E. W. Wolstenholme and C. M. O'Connor. Little, Brown and Co., Boston, Massachusetts, 1956, p. 187. Google Scholar53. SCADDING JG: Sarcoidosis, with special reference to lung changes. (Bradshaw lecture) Brit. Med. J. 1: 745, 1950. CrossrefMedlineGoogle Scholar54. LARSSONLILJESTRANDWAHLUND LGAH: Treatment of sarcoidosis with calciferol. Acta Med. Scand. 143: 280, 1952. CrossrefGoogle Scholar55. GRAHAMCAESARBURGEN LAJJAS: Gastrointestinal absorption and excretion of Mg. 28 in man. Metabolism 9: 646, 1960. MedlineGoogle Scholar56. NEUMANNEUMAN WFMW: The chemical dynamics of bone mineral. University of Chicago Press, Chicago, Illinois, 1958. Google Scholar57. HANNANORTHMACINTYREFRASER SKAIR: Magnesium metabolism in parathyroid disease. Brit. Med. J. 2: 1253, 1961. CrossrefMedlineGoogle Scholar58. HANNA S: Influence of large doses of vitamin D on magnesium metabolism in rats. Metabolism 10: 735, 1961. MedlineGoogle Scholar59. MCHARGUEROY JSWR: Effects of ultraviolet irradiation on magnesium content of rats receiving reflected sunlight and uniform stock ration. Amer. J. Physiol. 92: 651, 1930. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: BARBARA J. HUNT, M.B., CH.B.; EDMUND REINHOLD YENDT, M.D., F.R.C.P.Affiliations: Toronto,From the Department of Medicine, University of Toronto and the Farquharson Investigation Unit, Toronto General Hospital.This work was supported by grants from the Medical Research Council of Canada.Requests for reprints should be addressed to Edmund Reinhold Yendt, M.D., Department of Medicine, University of Toronto, 100 College Street, Toronto 5, Ontario, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMethotrexate Treatment for Sarcoidosis-Induced HypercalcemiaHypercalcemia Due to Vitamin D ToxicityHypercalcemia, Anemia, and Acute Kidney Injury: A Rare Presentation of SarcoidosisAffinity of chloroquine for boneHypercalcemia Due to Vitamin D ToxicityHypercalcemia and soft tissue calcification owing to sarcoidosis: The sunlight-cola connectionAntimalarials: unapproved uses or indicationsSarcoidosisAntimalarial Medications in DermatologyDisorders of Calcium MetabolismHydroxychloroquine is effective therapy for control of cutaneous sarcoidal granulomasGranulomatous infiltration of the talus and abnormal vitamin D and calcium metabolism in a patient with sarcoidosis: Successful treatment with hydroxychloroquineTreatment of HypercalcemiaAntimalarialsMineral MetabolismHydroxychloroquine treatment of hypercalcemia in a patient with sarcoidosis undergoing hemodialysisThe Role of the Ophthalmologist in the Management of SarcoidosisThe Effects of Chloroquine on Serum 1,25-Dihydroxyvitamin D and Calcium Metabolism in SarcoidosisAbnormal Calcium Homeostasis in SarcoidosisAnti-malarials in DermatologyCalciumstoffwechselst�rungen bei Sarkoidose Inzidenz, Ausmass, Pathogenese und renale FolgeerkrankungenParathyroid Physiology and Primary HyperparathyroidismPARTIAL ESCAPE OF MAGNESIUM FROM THE RENAL ACTION OF PARATHYROID HORMONE IN HYPERPARATHYROIDISMSarcoidosis with Hypercalcemia, Reversible Uremia and HyperparathyroidismThe infrequency of hypercalcemia in sarcoidosisFrequency of disordered calcium metabolism in sarcoidosisDiplopia and loss of accommodation due to chloroquineSarcoidosis and hyperparathyroidismEndocrine Aspects of SarcoidosisChloroquine in the treatment of sarcoidosisÜber die Behandlung der Sarkoidose mit ChloroquinCoexistent Sarcoidosis and HyperparathyroidismAbnormal Skeletal Mineral Metabolism in SarcoidosisJAMES Z. HENDRIX, M.D.Drugs in DermatologySarcoidosis 1 October 1963Volume 59, Issue 4 Page: 554-564 Keywords Calcium Hospital medicine Hypercalcemia Magnesium Muscular weakness Nausea Pathogenesis Renal failure Sarcoidosis Vomiting ePublished: 1 December 2008 Issue Published: 1 October 1963 PDF downloadLoading ...