Severe Hypercalcemia as an Initial Presentation of Advanced Hepatocellular Carcinoma: A Case Report

BACKGROUND: It is extremely rare for hypercalcemia to appear as the first symptom of hepatocellular carcinoma. Instead, it occurs primarily as a paraneoplastic manifestation after the disease is already diagnosed. METHODS: In this report, we describe a 55-year-old woman who presented with symptoms of acute severe hypercalcemia and was negative for hepatitis B surface antigen and hepatitis C virus antibodies. RESULTS: Laboratory tests confirmed hypercalcemia (serum calcium 16.2 mg/dL) with intact parathyroid hormone (2 pg/mL). Alpha-fetoprotein serum level was 3031.14 ng/mL. Abdominal ultrasonography and computed tomography revealed a big vascularized mass of 7 × 5.5cm in diameter, occupying most of the right lobe of the liver. CONCLUSION: Based on these findings, hepatocellular carcinoma may present late in disease progression with isolated hypercalcemia; therefore, HCC should be considered in the differential diagnosis in a hypercalcemic patient.