Parathryoid hormone related peptide causing hypercalcaemia in a patient with hepatocellular carcinoma

The incidence of hepatocellular carcinoma (HCC) is increasing. In addition, its presentation without bony metastasis as a part of paraneoplastic syndrome is recognised but uncommon. This unusual presentation of HCC is highlighted in the case of a 63 years old lady, who presented with lethargy and tiredness and hypercalcaemia due to secretion of parathryoid hormone related peptide (PTHrP). Further imaging showed 11 cm hepatic mass, with normal alpha fetoprotein. She underwent partial hepatectomy and is doing well since then. Malignant hypercalcaemia is thought to arise from the secretion of PTHrP which is synthesised by tumour cells and has a similar action to parathyroid hormone. Early recognition of this uncommon condition can lead to complete cure as seen in our patient.