Which Sarcoidosis Specialist

[Regalhank]

Recently diagnosed with sarcoidosis of the lung.  No real symptoms and it was purely by accident that it was discovered.  Thought it was lung cancer until a needle biopsy confirmed sarcoidosis.  Now, however, I am wondering if thinning of legs and buttocks is at all related.  His abdomen is as big or bigger than ever though with no real reason for that but his legs and getting thinner.  Actual weight only fluctuates a little.  Was operated on in November for hyperparathyroidism and given mega doses of Vitamin D which was stopped immediately after the sarcoidosis diagnosis.  Related?  The real question is which specialist to start with--rheumatologist or pulmonary physician?  Oddly, he does not have any breathing problems--ex-smoker.

[National Jewish]

Sarcoidosis can involve any part or organ of the body, including the central and peripheral nervous system and muscle.  Like hyperparathyroidism, it can also cause high blood calcium levels.  The information provided suggests minimal lung involvement with sarcoidosis and would explain the absence of breathing problems.  The administration of Vitamin D, following surgical removal of parathyroid tissue was probably in response to transient reduction of parathyroid function and resultant lowering of the serum calcium.

The loss of leg and buttock muscle can occur with hyperparathyroidism but can also be caused by involvement by sarcoidosis of the nerve supply to these muscles or even sarcoidosis in the muscles themselves.  It is important to know which of these is the cause as the treatment of it will be very different.

Your best bet would be to consult with a rheumatologist rather than a pulmonary physician.  The muscle changes should not be permanent, but I would not delay in arranging for consultation.  The rheumatologist may, in turn, decide to refer you to a neurologist and/or an endocrinologist.  You should probably see an endocrinologist, in any event, as the management of your parathyroid function will require specialized knowledge.

Good luck

[Regalhank]

Thank you for the response.  Yes, there already is an endorcinologist involved because of the parathyroid but will heed your advice to see a rheumatologist.