From the Guidelines
Elevated Angiotensin-Converting Enzyme (ACE) levels can be caused by various conditions, including sarcoidosis, granulomatous diseases, hyperthyroidism, Gaucher's disease, leprosy, lymphoma, and certain medications, as well as diabetes mellitus, liver diseases, and lung conditions. The most recent and highest quality study 1 provides guidance on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors, which can help identify potential causes of elevated ACE levels. Some key points to consider include:
- Granulomatous diseases like tuberculosis, histoplasmosis, and coccidioidomycosis can increase ACE levels
- Hyperthyroidism, Gaucher's disease, leprosy, and certain types of lymphoma may also raise ACE levels
- Medications, particularly corticosteroids, can affect ACE levels, while ACE inhibitors actually decrease ACE activity
- Diabetes mellitus, particularly with kidney involvement, can elevate ACE
- Liver diseases such as cirrhosis and hepatitis may increase ACE due to altered metabolism
- Certain lung conditions including silicosis, asbestosis, and berylliosis can raise ACE through granuloma formation
- Age is also a factor, as ACE levels tend to be higher in children and adolescents compared to adults It is essential to investigate these potential causes through additional testing to determine the underlying condition requiring treatment, as recommended by the European Society of Cardiology 1. Other studies, such as 1, 1, 1, and 1, provide additional information on the management of ACE inhibitors and potential causes of elevated ACE levels, but the most recent and highest quality study 1 should be prioritized.
From the Research
Causes of Elevated Angiotensin-Converting Enzyme (ACE) Levels
Elevated ACE levels are not exclusive to sarcoidosis, as they can be encountered in other medical conditions. Some of the causes of elevated ACE levels include:
- Non-Hodgkin's lymphoma 2
- Cirrhosis 2
- Interstitial lung disease 2
- Familial ACE hyperactivity, a benign condition that can be confirmed by genetic testing 3
- Certain ACE mutations that increase ACE shedding, which can lead to misdiagnosis of sarcoidosis 4
- Gaucher disease, as elevated blood ACE levels can also support diagnosis of this condition 4
Disease Correlation
Elevated ACE levels have been found to correlate poorly with disease activity in sarcoidosis patients 2. Additionally, a positive correlation between lack of cardiac involvement and elevated ACE levels was found on multivariate analysis 2.
Diagnostic Utility
The diagnostic utility of ACE levels for sarcoidosis has been found to be limited, with poor sensitivity and insufficient specificity 5. However, ACE levels can decrease after the initiation of immunosuppressive therapy, suggesting a potential role in monitoring treatment efficacy 6.