Primary Hyperparathyroidism May Be Underdiagnosed in Sarcoidosis

Primary hyperparathyroidism may be substantially underdiagnosed among adults with sarcoidosis, according to a large retrospective cohort study in The Journal of Clinical Endocrinology & Metabolism.

The study used the TriNetX U.S. Collaborative Network and included 117,395 adults with sarcoidosis and at least one serum calcium measurement. Investigators evaluated intact parathyroid hormone testing, biochemical and coded primary hyperparathyroidism, parathyroidectomy use, biochemical cure, and mortality.

Hypercalcemia was present in 31.3% of patients, but only 30.5% underwent intact parathyroid hormone assessment. Biochemical primary hyperparathyroidism was identified in 3.0%, and 75.4% of those cases had no corresponding ICD-10 diagnosis code.

Among patients with coded primary hyperparathyroidism, parathyroidectomy was performed in 36.6%, with biochemical cure reported in 74.6%. No parathyroidectomy was associated with higher mortality in the analysis.

The authors concluded that routine intact parathyroid hormone measurement and timely surgical referral are essential. The study highlights the risk of attributing hypercalcemia in sarcoidosis only to granuloma-mediated mechanisms and missing a surgically treatable endocrine cause.

Sources: Ghaleb A, et al. Prevalence and outcomes of primary hyperparathyroidism in sarcoidosis patients: a large-scale retrospective cohort study. J Clin Endocrinol Metab. 2026;dgag302. doi:10.1210/clinem/dgag302