Sarcoidosis laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
===Angiotensin-converting enzyme=== | ===[[Angiotensin-converting enzyme]]=== | ||
[[ACE]] is produced in [[epithelioid cells]] of [[granuloma]]s, therefor [[ACE]] levels may show the burden of [[sarcoidosis]] [[granuloma]]s in the body<ref>Shefield EA: Pathology of sarcoidosis. Clin Chest Med 18(4):741–754, 1997.</ref>. [[ACE]] has been proposed as a diagnostic test for [[sarcoidosis]], but the sensivity and specifity of an elevated [[ACE]] level is '''not''' enough to diagnose and/or rule out [[sarcoidosis]]<ref>Bunting PS, Szalai JP, Katic M: Diagnostic aspects of angiotensin converting enzyme in pulmonary sarcoidosis. Clin Biochem 20(3): 213–219, 1987.</ref>. | [[ACE]] is produced in [[epithelioid cells]] of [[granuloma]]s, therefor [[ACE]] levels may show the burden of [[sarcoidosis]] [[granuloma]]s in the body<ref>Shefield EA: Pathology of sarcoidosis. Clin Chest Med 18(4):741–754, 1997.</ref>. [[ACE]] has been proposed as a diagnostic test for [[sarcoidosis]], but the sensivity and specifity of an elevated [[ACE]] level is '''not''' enough to diagnose and/or rule out [[sarcoidosis]]<ref>Bunting PS, Szalai JP, Katic M: Diagnostic aspects of angiotensin converting enzyme in pulmonary sarcoidosis. Clin Biochem 20(3): 213–219, 1987.</ref>. | ||
* Sensivity: 77% | * Sensivity: 77% | ||
* Specifity: 93% | * Specifity: 93% | ||
* Serum ACE | * Serum ACE levels greater than two times the upper limit of normal are rarely seen in other disease<ref>Lieberman J, Nosal A, Schlessner A, Sastre-Foken A: Serum | ||
angiotensin-converting enzyme for diagnosis and therapeutic evaluation of sarcoidosis. Am Rev Respir Dis 120(2):329–335, 1979.</ref><ref>Silverstein E, Schussler GC, Friedland J: Elevated serum angiotensinconverting enzyme in hyperthyroidism. Am J Med 75(2):233–236, 1983.</ref>. | angiotensin-converting enzyme for diagnosis and therapeutic evaluation of sarcoidosis. Am Rev Respir Dis 120(2):329–335, 1979.</ref><ref>Silverstein E, Schussler GC, Friedland J: Elevated serum angiotensinconverting enzyme in hyperthyroidism. Am J Med 75(2):233–236, 1983.</ref>. | ||
===Serum [[chitotriosidase]]=== | ===Serum [[chitotriosidase]]=== | ||
Has been shown to be elevated in [[sarcoidosis]] and is associated with worse prognosis<ref>Bargagli E, Bennett D, Maggiorelli C, et al: Human chitotriosidase: a | |||
sensitive biomarker of sarcoidosis. J Clin Immunol 33(1):264–270, 2013.</ref><ref>Bargagli E, Bianchi N, Margollicci M, et al: Chitotriosidase and soluble IL-2 receptor: comparison of two markers of sarcoidosis severity. Scand J Clin Lab Invest 68(6):479–483, 2008.</ref>. | sensitive biomarker of sarcoidosis. J Clin Immunol 33(1):264–270, 2013.</ref><ref name="inter">Bargagli E, Bianchi N, Margollicci M, et al: Chitotriosidase and soluble IL-2 receptor: comparison of two markers of sarcoidosis severity. Scand J Clin Lab Invest 68(6):479–483, 2008.</ref>. | ||
===[[Soluble interleukin-2 receptor]]=== | |||
The [[soluble interleukin-2 receptor]] is a marker of T-cell activation and found to be elevated in [[sarcoidosis]] patients and can be as an effective marker of disease activity<ref name="inter">Bargagli E, Bianchi N, Margollicci M, et al: Chitotriosidase and soluble IL-2 receptor: comparison of two markers of sarcoidosis severity. Scand J Clin Lab Invest 68(6):479–483, 2008.</ref><ref>Grutters JC, Fellrath JM, Mulder L, et al: Serum soluble interleukin-2 receptor measurement in patients with sarcoidosis: a clinical evaluation. Chest 124(1):186–195, 2003.</ref>. | |||
===[[Hypercalcemia]]=== | ===[[Hypercalcemia]]=== | ||
[[Hypercalcemia]] and/or [[hypercalciuria]] is seen in up to 30% of patients diagnosed with [[sarcoidosis]]<ref>Rizzato G, Fraioli P, Montemurro L: Nephrolithiasis as a presenting feature of chronic sarcoidosis. Thorax 50(5):555–559, 1995.</ref>.Levels of [[1,25-dihydroxyvitamin D]] may be elevated despite low levels of [[25 hydroxyvitamin D]]<ref>Baughman RP, Janovcik J, Ray M, et al: Calcium and vitamin D metabolism in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 30(2):113–120, 2013.</ref>. | [[Hypercalcemia]] and/or [[hypercalciuria]] is seen in up to 30% of patients diagnosed with [[sarcoidosis]]<ref>Rizzato G, Fraioli P, Montemurro L: Nephrolithiasis as a presenting feature of chronic sarcoidosis. Thorax 50(5):555–559, 1995.</ref>. Levels of [[1,25-dihydroxyvitamin D]] may be elevated despite low levels of [[25 hydroxyvitamin D]]<ref>Baughman RP, Janovcik J, Ray M, et al: Calcium and vitamin D metabolism in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 30(2):113–120, 2013.</ref>. | ||
===[[Kveim test]]=== | |||
In this test a suspension of splenic cells from patients with [[sarcoidosis]] (kveim-siltzbach reagent), is injected intradermally to evoke sarcoid granulomatous response over 3 weeks. It is a research tool rather than a diagnostic method. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 21:23, 10 May 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Roshan Dinparasti Saleh M.D.
Overview
Although serum ACE level has been proposed as a diagnostic test for sarcoidosis, the sensivity and specifity of an elevated ACE level, is not enough to diagnose and/or rule out sarcoidosis.
Laboratory Findings
Angiotensin-converting enzyme
ACE is produced in epithelioid cells of granulomas, therefor ACE levels may show the burden of sarcoidosis granulomas in the body[1]. ACE has been proposed as a diagnostic test for sarcoidosis, but the sensivity and specifity of an elevated ACE level is not enough to diagnose and/or rule out sarcoidosis[2].
- Sensivity: 77%
- Specifity: 93%
- Serum ACE levels greater than two times the upper limit of normal are rarely seen in other disease[3][4].
Serum chitotriosidase
Has been shown to be elevated in sarcoidosis and is associated with worse prognosis[5][6].
Soluble interleukin-2 receptor
The soluble interleukin-2 receptor is a marker of T-cell activation and found to be elevated in sarcoidosis patients and can be as an effective marker of disease activity[6][7].
Hypercalcemia
Hypercalcemia and/or hypercalciuria is seen in up to 30% of patients diagnosed with sarcoidosis[8]. Levels of 1,25-dihydroxyvitamin D may be elevated despite low levels of 25 hydroxyvitamin D[9].
Kveim test
In this test a suspension of splenic cells from patients with sarcoidosis (kveim-siltzbach reagent), is injected intradermally to evoke sarcoid granulomatous response over 3 weeks. It is a research tool rather than a diagnostic method.
References
- ↑ Shefield EA: Pathology of sarcoidosis. Clin Chest Med 18(4):741–754, 1997.
- ↑ Bunting PS, Szalai JP, Katic M: Diagnostic aspects of angiotensin converting enzyme in pulmonary sarcoidosis. Clin Biochem 20(3): 213–219, 1987.
- ↑ Lieberman J, Nosal A, Schlessner A, Sastre-Foken A: Serum angiotensin-converting enzyme for diagnosis and therapeutic evaluation of sarcoidosis. Am Rev Respir Dis 120(2):329–335, 1979.
- ↑ Silverstein E, Schussler GC, Friedland J: Elevated serum angiotensinconverting enzyme in hyperthyroidism. Am J Med 75(2):233–236, 1983.
- ↑ Bargagli E, Bennett D, Maggiorelli C, et al: Human chitotriosidase: a sensitive biomarker of sarcoidosis. J Clin Immunol 33(1):264–270, 2013.
- ↑ 6.0 6.1 Bargagli E, Bianchi N, Margollicci M, et al: Chitotriosidase and soluble IL-2 receptor: comparison of two markers of sarcoidosis severity. Scand J Clin Lab Invest 68(6):479–483, 2008.
- ↑ Grutters JC, Fellrath JM, Mulder L, et al: Serum soluble interleukin-2 receptor measurement in patients with sarcoidosis: a clinical evaluation. Chest 124(1):186–195, 2003.
- ↑ Rizzato G, Fraioli P, Montemurro L: Nephrolithiasis as a presenting feature of chronic sarcoidosis. Thorax 50(5):555–559, 1995.
- ↑ Baughman RP, Janovcik J, Ray M, et al: Calcium and vitamin D metabolism in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 30(2):113–120, 2013.