Sarcoidosis: initial laboratory tests and monitoring
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Suspected or recently diagnosed sarcoidosis: initial tests
Fasting laboratory tests
- FBC, platelets
- Serum electrolytes
- Serum creatinine with eGFR
- Serum calcium
- Serum albumin
- AST
- ALT
- GGT
- Alkaline phosphatase
- Bilirubin
- Serum protein electrophoresis
- Angiotensin-converting enzyme (interpret on an ACE inhibitor: falsely normal)
- IGRA, or tuberculin skin test (if epidemiological risk of tuberculosis, or before anti-TNF)if neededThe PNDS recommends it in patients at epidemiological risk of tuberculosis and imperatively before an anti-TNF; before corticosteroids or an immunosuppressant, it is a matter for discussion [2]. The PNDS accepts the tuberculin skin test or the IGRA test [2].
- HIV serologyif neededTests before treatment with corticosteroids or an immunosuppressant suggested by the PNDS [2].
- Hepatitis B serologyif neededTests before treatment with corticosteroids or an immunosuppressant suggested by the PNDS [2].
- Hepatitis C serologyif neededTests before treatment with corticosteroids or an immunosuppressant suggested by the PNDS [2].
- Fasting plasma glucose and HbA1c (before corticosteroids)if neededTests before corticosteroid therapy suggested by the PNDS [2].
- 25-hydroxyvitamin D AND 1,25-dihydroxyvitamin D (calcitriol), only if vitamin D supplementation is being consideredif neededIf vitamin D is measured (before supplementation, for example), measure both 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, because of the risk of hypercalcaemia if the latter is high [2].
24-hour urine collection
- Urinary calcium
- 24-hour urine creatinine
Do not order
Sarcoidosis under follow-up: laboratory monitoring
Once a year
- Serum calcium
- Serum albumin
- Serum creatinine with eGFR
- Alkaline phosphatase
- Angiotensin-converting enzyme (if it was raised at baseline, especially on treatment)if neededIf its value was initially high, angiotensin-converting enzyme can be repeated to assess activity, especially on treatment; its value for therapeutic decisions has not been evaluated [2].
On corticosteroids: within the first 2 weeks
- Serum electrolytes
- Fasting plasma glucose (then at every visit until corticosteroids are stopped)
Also consider
- On corticosteroids? For monitoring, see the page "Treatment: long-term corticosteroids".
- On methotrexate? See the page "Treatment: methotrexate (low weekly dose)".
Sources (5)
- Centre de référence constitutif des maladies pulmonaires rares OrphaLung, filière RespiFil. Sarcoïdose pulmonaire : synthèse à destination du médecin traitant, extraite du PNDS. Haute Autorité de santé, mars 2026 (mise en ligne en avril 2026).
- Centre de référence constitutif des maladies pulmonaires rares OrphaLung, filière RespiFil. Protocole national de diagnostic et de soins (PNDS) : sarcoïdose pulmonaire. Haute Autorité de santé, mars 2026 (mis en ligne en avril 2026).
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1139 (25-OH-vitamine D), 4103 (test IGRA) et 1577 (HbA1c), texte des limitations de prise en charge.
- Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;201(8):e26-e51.
- Thillai M, Atkins CP, Crawshaw A, et al. BTS Clinical Statement on pulmonary sarcoidosis. Thorax. 2021;76(1):4-20 (publiée en ligne le 2 décembre 2020).