How do you manage hypercalcemia in sarcoidosis despite being on immunosuppressive therapy?

Let us accept, first, that the individual does not have emergent levels of elevated calcium (equal to around or greater than 14 mg/dl) and concerning symptoms of the following systems: neurological (e.g., weakness, confusion, delirium), renal (e.g., polyuria, polydipsia), gastrointestinal (e.g., loss of appetite, nausea and vomiting), cardiovascular (e.g., arrhythmias, short Q-T interval). Then the approach becomes a diagnostic exercise to inform management decisions. Importantly, we should not simply assume that the hypercalcemia is due to sarcoidosis activity that has "broken through" the immunosuppressive regimen. One should rule out other causes of hypercalcemia. The key test is to measure a PTH level. A high PTH level would indicate a ...