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Possible Sarcoidosis?
Hey All,
I have been struggling with problems for the past 10 months. I am a 25 year old male. My serum calcium level has fluctuated from high normal to slightly elevated over the past 10 months. I have had every test under the sun. I have had an SPEP and UPEP for myeloma, EMG
I have been struggling with problems for the past 10 months. I am a 25 year old male. My serum calcium level has fluctuated from high normal to slightly elevated over the past 10 months. I have had every test under the sun. I have had an SPEP and UPEP for myeloma, EMG
The pulmonary doctor will need that for your evaluation. As well as a CT scan of your chest? Patients with sarcoid can have normal pft results. You may also consider seeing a optometrist and a dermatologist. Sarcoid is a chronic disorder of unknown orgin. Here is what the National jewish medical and research center has to say: njc.org
An evaluation to detect sarcoidosis should include the following:
Thorough Medical Examination
A thorough medical examination can help "rule out" other diseases that may be similar to sarcoidosis.
Chest X-Ray
Doctors look at the X-ray for evidence of enlarged lymph nodes and small round spots in the lung caused by the clusters of inflammation. "Staging" can help the doctor determine the degree of lung involvement in sarcoidosis. A scale of 0-IV (zero to four) is commonly used with IV having the highest amount of lung involvement.
Pulmonary Function Tests
Standard breathing tests give an indication of the severity of lung disease. There is nothing unique about sarcoidosis on these tests, so they do not substitute for other, more specific tests. Pulmonary function tests can show obstruction of air flow out of the lungs, restriction of the lung's ability to take in air, and a decrease in the transport of oxygen from the lung into the blood stream. The most important types of breathing tests in sarcoidosis are spirometry, lung volumes, and diffusing capacity. In some cases, measurement of blood oxygen levels during an exercise test should also be done.
Tissue biopsy
A microscopic examination of tissue samples from the lungs or other affected organs is needed to be absolutely sure of the diagnosis. A bronchoscopy can obtain this tissue. A bronchoscopy is an outpatient procedure in which the doctor places a narrow tube through the nose and into the airways. Sometimes the diagnosis is made by obtaining tissue samples from the skin, liver, or enlarged lymph nodes.
Bronchoalveolar Lavage
When a bronchoscopy is done, a small part of lung can be washed (lavaged) in order to obtain some cells of the immune system from the lung. By counting the types of cells in lavage fluid, it is possible to get an estimate of how inflamed the lungs are, and whether the type of inflammation is characteristic of sarcoidosis. This procedure is routinely used at a number of medical centers (including National Jewish Medical and Research Center), and may also provide a great deal of information for research into this disorder.
Eye Examination
A slit lamp examination by an eye doctor (ophthalmologist) is an important part of an eye examination to detect inflammation.
S.A.C.E. (Serum Angiotensin Converting Enzyme Level)
S.A.C.E. is a blood test. If the level of this blood test is high, it can indicate the presence of sarcoidosis. It can sometimes be used to monitor if sarcoidosis is improving or worsening. Unfortunately, other diseases can cause increased S.A.C.E. blood levels also, so this test cannot be used alone to make the diagnosis.
CT Scan
A CT Scan is a detailed type of X-ray. The CT scan may make it possible to see lymph nodes and scars in the lung when regular chest X-rays sometimes cannot.
Gallium Scan
The Gallium scan is a type of X-ray scan. A small amount of radioactive material is injected into a person's blood, which travels to areas of the body that are inflamed. An X-ray camera scans the body to see where the radioactive material has collected. Although not needed in all cases, gallium scanning can help show sarcoidosis in many organs, including the lungs, salivary glands, bone, spleen, and liver.
Calcium Levels in the Blood and Urine
People with sarcoidosis can have sensitivity to vitamin D. This results in too much calcium being absorbed through the intestines. This can cause a high level of calcium in the blood and urine. Exposure to the sun can further stimulate this process. It may be necessary to collect a urine sample for 24 hours to measure the calcium level as well as collect a blood sample for calcium. There are rarely symptoms seen with high levels of calcium in the blood. If symptoms are present they may include vague bone pain and frequent urination.
Good luck
An evaluation to detect sarcoidosis should include the following:
Thorough Medical Examination
A thorough medical examination can help "rule out" other diseases that may be similar to sarcoidosis.
Chest X-Ray
Doctors look at the X-ray for evidence of enlarged lymph nodes and small round spots in the lung caused by the clusters of inflammation. "Staging" can help the doctor determine the degree of lung involvement in sarcoidosis. A scale of 0-IV (zero to four) is commonly used with IV having the highest amount of lung involvement.
Pulmonary Function Tests
Standard breathing tests give an indication of the severity of lung disease. There is nothing unique about sarcoidosis on these tests, so they do not substitute for other, more specific tests. Pulmonary function tests can show obstruction of air flow out of the lungs, restriction of the lung's ability to take in air, and a decrease in the transport of oxygen from the lung into the blood stream. The most important types of breathing tests in sarcoidosis are spirometry, lung volumes, and diffusing capacity. In some cases, measurement of blood oxygen levels during an exercise test should also be done.
Tissue biopsy
A microscopic examination of tissue samples from the lungs or other affected organs is needed to be absolutely sure of the diagnosis. A bronchoscopy can obtain this tissue. A bronchoscopy is an outpatient procedure in which the doctor places a narrow tube through the nose and into the airways. Sometimes the diagnosis is made by obtaining tissue samples from the skin, liver, or enlarged lymph nodes.
Bronchoalveolar Lavage
When a bronchoscopy is done, a small part of lung can be washed (lavaged) in order to obtain some cells of the immune system from the lung. By counting the types of cells in lavage fluid, it is possible to get an estimate of how inflamed the lungs are, and whether the type of inflammation is characteristic of sarcoidosis. This procedure is routinely used at a number of medical centers (including National Jewish Medical and Research Center), and may also provide a great deal of information for research into this disorder.
Eye Examination
A slit lamp examination by an eye doctor (ophthalmologist) is an important part of an eye examination to detect inflammation.
S.A.C.E. (Serum Angiotensin Converting Enzyme Level)
S.A.C.E. is a blood test. If the level of this blood test is high, it can indicate the presence of sarcoidosis. It can sometimes be used to monitor if sarcoidosis is improving or worsening. Unfortunately, other diseases can cause increased S.A.C.E. blood levels also, so this test cannot be used alone to make the diagnosis.
CT Scan
A CT Scan is a detailed type of X-ray. The CT scan may make it possible to see lymph nodes and scars in the lung when regular chest X-rays sometimes cannot.
Gallium Scan
The Gallium scan is a type of X-ray scan. A small amount of radioactive material is injected into a person's blood, which travels to areas of the body that are inflamed. An X-ray camera scans the body to see where the radioactive material has collected. Although not needed in all cases, gallium scanning can help show sarcoidosis in many organs, including the lungs, salivary glands, bone, spleen, and liver.
Calcium Levels in the Blood and Urine
People with sarcoidosis can have sensitivity to vitamin D. This results in too much calcium being absorbed through the intestines. This can cause a high level of calcium in the blood and urine. Exposure to the sun can further stimulate this process. It may be necessary to collect a urine sample for 24 hours to measure the calcium level as well as collect a blood sample for calcium. There are rarely symptoms seen with high levels of calcium in the blood. If symptoms are present they may include vague bone pain and frequent urination.
Good luck
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