pulmonary disorders
Sarcoidosis
Key Points
Systemic and extrapulmonary involvement is common with sarcoidosis, but > 90% of adult patients have pulmonary involvement. Obtain a chest imaging study but confirm the diagnosis by biopsy, usually endobronchial ultrasound-guided transbronchial needle aspiration of a mediastinal or hilar lymph node. Assess pulmonary severity with pulmonary function testing and exercise pulse oximetry. Test for extrapulmonary involvement with ECG, slit-lamp examination, renal and hepatic function tests, and serum and urinary calcium testing. Treat patients with systemic corticosteroids when indicated (eg, severe symptoms, hypercalcemia, progressive decline in organ function, cardiac or neurologic involvement). Treat with immunosuppressants if patients cannot tolerate moderate doses of corticosteroids, sarcoidosis is resistant to corticosteroids, or if corticosteroids are required long term. 