Inflammation and repair: sarcoidosis hypercalcaemia: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Inflammation and repair: sarcoidosis hypercalcaemia

Sample item

A 35-year-old woman with bilateral hilar lymphadenopathy and non-caseating granulomas has a serum calcium of 12.5 mg/dL. What is the mechanism of the hypercalcaemia?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Granuloma macrophages convert vitamin D to its active form

Activated macrophages in sarcoid granulomas express 1-alpha hydroxylase, so they make calcitriol independent of calcium and PTH. This increases gut calcium absorption, and PTH is suppressed.

Option by option

  • A. Autonomous parathyroid secretion

    Primary hyperparathyroidism would have high PTH, while sarcoid hypercalcaemia has low PTH.

  • B. Granuloma macrophages convert vitamin D to its active form (correct)

    Correct. Extra-renal 1-alpha hydroxylase in granuloma macrophages raises calcitriol.

  • C. Osteolysis by metastases

    Sarcoid is not metastatic, and bone metastases are not present.

  • D. Secretion of PTH-related protein by granuloma cells

    PTHrP is made by squamous carcinomas and some lymphomas and is not the mechanism in sarcoid.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Granuloma macrophages convert vitamin D to its active form. Activated macrophages in sarcoid granulomas express 1-alpha hydroxylase, so they make calcitriol independent of calcium and PTH.

Why is "Autonomous parathyroid secretion" not the answer?

Primary hyperparathyroidism would have high PTH, while sarcoid hypercalcaemia has low PTH.

Why is "Osteolysis by metastases" not the answer?

Sarcoid is not metastatic, and bone metastases are not present.

Why is "Secretion of PTH-related protein by granuloma cells" not the answer?

PTHrP is made by squamous carcinomas and some lymphomas and is not the mechanism in sarcoid.

What concept does this question test?

It tests Inflammation and repair: sarcoidosis hypercalcaemia in Pathology. This increases gut calcium absorption, and PTH is suppressed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Inflammation and repair: sarcoidosis hypercalcaemia?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.