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Abstract: SA-PO507

Hypercalcemia, It's Not Always Cancer: Unique Case of Sarcoidosis Presenting as a Testicular Mass

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Zaman, Azkaa, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Randhawa, Navkiran, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Marwaha, Suraj, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Elsayed, Norhan, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Lehne, Ramier J., Franciscan Health Inc, Mishawaka, Indiana, United States
  • Wadud, Mohammad H., Franciscan Health Inc, Mishawaka, Indiana, United States
  • Patel, Sunil, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Siegert, James J., Franciscan Health Inc, Mishawaka, Indiana, United States
  • Brill, April, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Sarguroh, Tauseef A., Franciscan Health Inc, Mishawaka, Indiana, United States
Introduction

Sarcoidosis is a multi-system disease typically seen in young adults with a prevalence of about 50 to 160 per 100,000 population worldwide. The disease pathology is thought to involve the accumulation of T lymphocytes, mononuclear phagocytes and noncaseating granulomas in the lungs, eyes, skin and lymph nodes. We report a unique case of systemic sarcoidosis in a patient with severe hypercalcemia, acute renal failure and a testicular mass.

Case Description

A 44 year old male with history of Hypertension, Type 2 Diabetes, Obesity presented with a painless left testicular mass and 70 pound weight loss over five months. On admission he was noted to have a serum creatinine of 4.6 mg/dL, serum calcium of 17.2 mg/dL with appropriately suppressed intact PTH of 7 pg/mL and an elevated vitamin D 1,25-dihydroxy of 80.2 pg/mL. A kidney biopsy showed acute tubular necrosis with no immune complex deposition or paraprotein mediated disease. CT chest, abdomen and pelvis revealed several bilateral pulmonary nodules and diffuse lymphadenopathy including mediastinal, periaortic and bilateral inguinal chains. A scrotal ultrasound revealed a solid calcified mass lateral to the left testis. Urology performed a left inguino femoral lymph node dissection and a left partial orchiectomy. Frozen section was negative for malignancy and final pathology showed granulomatous lymphadenitis consitent with sarcoidosis. The patient was treated medically for hypercalcemia and discharged on oral corticosteroids.

Discussion

Typically, sarcoidosis presents with pulmonary symptoms. This is a rare presentation of severe hypercalcemia in a patient with a testicular mass which emphasizes that physicians should be aware of extrapulmonary manifestations of sarcoidosis when evaluating a patient presenting with hypercalcemia and renal failure.

Calcified mass superior to left testis on ultrasound