This b has Sarcoidosis so her granulomas be activatin dat VitD
This patient definitely has Sarcoidosis.
Clues in question stem:
-African American Female
-Bilateral Hilar Adenopathy
-Hypercalcemia (due to 1α-hydroxylase–mediated vitamin D activation in macrophages).
FA 2018 (P. 658)
In sarcoidosis, hypercalcemia normally suppresses the release of PTH and therefore the production of calcitriol (1,25-dihydroxycholecalciferol), but in sarcoidosis and other granulomatous diseases, activated mononuclear cells (particularly macrophages) in the lung and lymph nodes produce calcitriol (1,25-dihydroxycholecalciferol) from calcidiol (25-hydroxycholecalciferol) independent of PTH.
A "serum Ca concentration of 16 mg/dL" as well as "bilateral hilar adenopathy" indicate squamous cell carcinoma which commonly produces PTHrP, NOT PTH!!! PTHrP will act just as PTH, stimulating the kidney to produce 1,25-(OH)2 Vit D.