Sarcoidosis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Roshan Dinparasti Saleh M.D.


Overview

Although serum ACE level has been proposed as a diagnostic test for sarcoidosis, the sensivity and specifity of an elevated ACE level, is not enough to diagnose and/or rule out sarcoidosis.

Laboratory Findings

Angiotensin-converting enzyme

ACE is produced in epithelioid cells of granulomas, therefor ACE levels may show the burden of sarcoidosis granulomas in the body[1]. ACE has been proposed as a diagnostic test for sarcoidosis, but the sensivity and specifity of an elevated ACE level is not enough to diagnose and/or rule out sarcoidosis[2].

  • Sensivity: 77%
  • Specifity: 93%
  • Serum ACE level greater than two times the upper limit of normal are rarely seen in other disease[3][4].

Serum chitotriosidase

has been shown to be elevated in sarcoidosis and is associated with worse prognosis[5][6].

Hypercalcemia

Hypercalcemia and/or hypercalciuria is seen in up to 30% of patients diagnosed with sarcoidosis[7].Levels of 1,25-dihydroxyvitamin D may be elevated despite low levels of 25 hydroxyvitamin D[8].

References

  1. Shefield EA: Pathology of sarcoidosis. Clin Chest Med 18(4):741–754, 1997.
  2. Bunting PS, Szalai JP, Katic M: Diagnostic aspects of angiotensin converting enzyme in pulmonary sarcoidosis. Clin Biochem 20(3): 213–219, 1987.
  3. Lieberman J, Nosal A, Schlessner A, Sastre-Foken A: Serum angiotensin-converting enzyme for diagnosis and therapeutic evaluation of sarcoidosis. Am Rev Respir Dis 120(2):329–335, 1979.
  4. Silverstein E, Schussler GC, Friedland J: Elevated serum angiotensinconverting enzyme in hyperthyroidism. Am J Med 75(2):233–236, 1983.
  5. Bargagli E, Bennett D, Maggiorelli C, et al: Human chitotriosidase: a sensitive biomarker of sarcoidosis. J Clin Immunol 33(1):264–270, 2013.
  6. Bargagli E, Bianchi N, Margollicci M, et al: Chitotriosidase and soluble IL-2 receptor: comparison of two markers of sarcoidosis severity. Scand J Clin Lab Invest 68(6):479–483, 2008.
  7. Rizzato G, Fraioli P, Montemurro L: Nephrolithiasis as a presenting feature of chronic sarcoidosis. Thorax 50(5):555–559, 1995.
  8. Baughman RP, Janovcik J, Ray M, et al: Calcium and vitamin D metabolism in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 30(2):113–120, 2013.

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