What causes elevated calcitriol (108.5 pg/ml) with elevated serum ca, normal pth. no granuloma disease.

Measure 25(OH)D: Calcitriol, 25(OH)2D, is usually elevated in granulomatous diseases such as sarcoidosis, in lymphomas or in primary hyperparathyroidism, as you suggest. Calcitriol is quite influenced by intestinal absorption of calcium; 25(OH)D is the vitamin D metabolite usually measured (not DI-hydroxy/2D). Add a 25(OH)D measurement & work with your doctor to pursue the other causes of hypercalcemia. Good luck!