Abstract：
A 70-year-old female patient was admitted for close examination and treatment of hypercalcemia (corrected serum calcium levels: 3.04 mmol/L) and renal dysfunction (serum creatinine levels: 254.59 µmol/L). The patient had a history of sarcoidosis, diagnosed based on epithelioid cell granulomas in subcutaneous nodule biopsies, uveitis, and bilateral hilar lymphadenopathy, which had spontaneously remitted 10 years before admission. Because the patient was diagnosed with hypercalcemia associated with recurrent sarcoidosis, prednisone (20 mg/day) was initiated, and its dose was tapered following the decrease in serum calcium and creatinine levels. However, the levels of these parameters increased again when the prednisone dose was reduced to ≤ 4 mg/day. We were concerned about glucocorticoid-induced osteoporosis in the patient but hesitated to use first-line bisphosphonates because of renal dysfunction. Therefore, denosumab was initiated to reduce the risk of hypercalcemia, renal dysfunction, and glucocorticoid-induced osteoporosis. Serum creatinine and corrected serum calcium levels subsequently decreased. The prednisone dose could be reduced following repeated denosumab administration.Thus, denosumab can be a multifaceted, beneficial option for sarcoidosis-induced hypercalcemia, as it alleviates renal dysfunction indirectly by normalizing serum calcium levels, facilitates reduction of the glucocorticoid dose, and ameliorates glucocorticoid-induced osteoporosis.
摘要：
一名70岁的女性患者因高钙血症（校正的血清钙水平：3.04mmol/L）和肾功能不全（血清肌酐水平：254.59µmol/L）的密切检查和治疗而入院。患者有结节病病史,根据皮下结节活检中的上皮样细胞肉芽肿诊断，葡萄膜炎,和双侧肺门淋巴结肿大，入院前10年自发缓解。因为患者被诊断为与结节病复发相关的高钙血症，开始泼尼松（20毫克/天），随着血清钙和肌酐水平的下降，其剂量逐渐减少。然而,当泼尼松剂量降至≤4mg/天时,这些参数的水平再次升高.我们担心患者中糖皮质激素引起的骨质疏松症，但由于肾功能不全而不愿使用一线双膦酸盐。因此,denosumab是为了降低高钙血症的风险，肾功能不全,和糖皮质激素诱导的骨质疏松症。血清肌酐和校正的血清钙水平随后下降。重复给药后，泼尼松剂量可以减少。因此，denosumab可以是多方面的，结节病诱导的高钙血症的有益选择，因为它通过使血清钙水平正常化间接缓解肾功能障碍，有利于减少糖皮质激素剂量，并改善糖皮质激素诱导的骨质疏松症。
