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Sarcoidosis

Low vitamin D and sarcoidosis

04/16/2007

Question:

I had a vitamin D level of 21.6 so was started on 50,000 IU of Drisdol. I have systemic sarcoid (even have an AICD for cardiac sarcoid). I thought vitamin D was something a sarcoid pt had to be very careful with as far as too much. My calcium level is 10. Is 50,000 IU qd a concern? Thank you for your time.

Answer:

The role of vitamin D in sarcoidosis is, as you suggest, controversial. Some believe that vitamin D deficiency is associated with incomplete granulomatous responses (unresolved inflammation) while others believe that vitamin D triggers activation of sarcoidosis. The latter is based on the fact that some patients with sarcoidosis produce large amounts of active vitamin D which leads to calcium overload.

Despite the severity of your sarcoidosis, you apparently do not produce excess vitamin D. In fact, you are deficient in this vitamin. Your doctors have to help you determine if the risk of low vitamin D (osteoporosis) exceeds the risk of further activating your sarcoidosis (this risk is hard to determine based on what we currently know).

The risk of osteoporosis in the setting of vitamin D deficiency is well-established. The risk of normalizing low vitamin D levels in the setting of sarcoidosis is not known. Thus, it is reasonable to reduce your risk of osteoporosis (vitamin D replacement), but I would avoid excessive vitamin D intake. You should consult your doctor regarding the proper replacement dose, since they will be monitoring your response to treatment.

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University