The Bottom Line: Involvement of the liver is very common in patients with sarcoidosis. The diagnosis depends on the methodology and the diagnostic procedure followed. In autopsy series hepatic granulomas are found in as much as 70% of cases with sarcoidosis.
Summary: Abnormalities in liver function tests (LFTs) are encountered in 20-40% of patients but clinical expression of hepatic disease is not commonly observed. Most patients with hepatic sarcoidosis are asymptomatic and have normal liver enzyme tests. Hepatosplenomegaly (15-40%) and abdominal pain (5-15%) are the commonest clinical findings. Depending on disease activity hyperglobulinaemia, increased serum alkaline phosphatase (ALP), γ-GT, bilirubin (usually < 5 mg/dL) and slightly elevated transaminase levels are typical laboratory findings. Increased ALP can be found in as much as 90% of patients with signs and symptoms of hepatic disease but only in 10-15% of cases with only histological evidence. Serum angiotensin converting enzyme (SACE) is usually elevated but not pathognomonic. Serial measurements are implemented to monitor disease activity, response to treatment and ongoing relapse. Increased levels of calcium (10-20% of patients) due to overproduction of 1, 25-dihydroxycholecalciferol from activated macrophages, as well as elevated levels of Ca19-9 in cholestasis can be encountered.