Which of the following is a listed cause of hypercalcemia?

• A. Hypothyroidism
• B. Pancreatitis
• C. Cimetidine
• D. Sarcoidosis

Answer: (D)

Hypercalcemia results when calcium entry into the blood outpaces its excretion or deposition, and it often comes from either increased bone resorption or increased intestinal absorption. In granulomatous diseases like sarcoidosis, macrophages within granulomas express 1-alpha hydroxylase, which converts vitamin D to its active form, calcitriol, outside the kidney. This raises intestinal calcium absorption and lowers PTH through feedback, leading to elevated calcium levels. That mechanism makes sarcoidosis a classic listed cause of hypercalcemia.

The other options don’t fit this pattern. Hypothyroidism isn’t a typical cause of high calcium. Pancreatitis more commonly leads to low calcium due to fat saponification and calcium sequestration. Cimetidine isn’t associated with hypercalcemia. So the finding aligns with sarcoidosis as the cause.