{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T08:24:56Z","timestamp":1787214296926,"version":"build-2736575974"},"reference-count":10,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Severe hypercalcemia is commonly attributed to malignancy. Maintaining a broad differential diagnosis is important in patients with end-organ disease. We present a 47-year-old man with end-stage alcoholic cirrhosis who presented to the outpatient clinic with profound hypercalcemia. His albumin-corrected calcium was 16.8\u2005mg\/dL (SI: 4.2\u2005mmol\/L) (reference range, 8.5-10.1\u2005mg\/dL [SI: 2.1-2.5\u2005mmol\/L]) and he had an acute kidney injury. Laboratory evaluation revealed a suppressed parathyroid hormone. Imaging excluded malignancy. Workup for adrenal insufficiency suggested partial secondary disease as a contributing factor. With aggressive fluid hydration and corticosteroids, his symptoms and biochemistry improved. His calcium remained mildly elevated consistent with ongoing cirrhosis-related hypercalcemia. This case underscores the importance of maintaining a broad differential for severe hypercalcemia and considering cirrhosis itself as an etiologic factor.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag218","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T13:42:31Z","timestamp":1785159751000},"source":"Crossref","is-referenced-by-count":0,"title":["Severe hypercalcemia in a patient with end-stage liver disease"],"prefix":"10.1210","volume":"4","author":[{"given":"Arian","family":"Akhyari","sequence":"first","affiliation":[{"name":"Schulich School of Medicine and Dentistry, Western University , London, ON , N6A 3K7","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9636-5597","authenticated-orcid":false,"given":"Kristin K","family":"Clemens","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine and Dentistry, Western University , London, ON , N6A 3K7","place":["Canada"]},{"name":"Department of Medicine, Division of Endocrinology and Metabolism, Western University , London, ON , N6A 4V2","place":["Canada"]},{"name":"Department of Epidemiology and Biostatistics, Western University , London, ON , N6G 2M1","place":["Canada"]},{"name":"Lawson Research Institute , London, ON , N6A 4V2","place":["Canada"]},{"name":"Centre for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care , London , ON, Canada N6A 4V2"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"issue":"7","key":"2026082004023367100_luag218-B1","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.1210\/jcem.94.7.9987","article-title":"High blood calcium (hypercalcemia)","volume":"94","author":"Leder","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"Supplement_1","key":"2026082004023367100_luag218-B2","doi-asserted-by":"crossref","first-page":"A196","DOI":"10.1210\/jendso\/bvab048.398","article-title":"Hypercalcemia due to immobilization","volume":"5","author":"Ahamed","year":"2021","journal-title":"J Endocr Soc"},{"issue":"10","key":"2026082004023367100_luag218-B3","doi-asserted-by":"crossref","DOI":"10.1210\/jendso\/bvac115","article-title":"Adrenal insufficiency in cirrhosis","volume":"6","author":"Wentworth","year":"2022","journal-title":"J Endocr Soc"},{"issue":"4","key":"2026082004023367100_luag218-B4","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s11154-024-09874-0","article-title":"Adrenal insufficiency in liver diseases\u2014pathophysiology and underlying mechanisms","volume":"25","author":"Kalafateli","year":"2024","journal-title":"Rev Endocr Metab Disord"},{"issue":"2","key":"2026082004023367100_luag218-B5","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.jhep.2010.06.034","article-title":"Assessment of adrenocortical reserve in stable patients with cirrhosis","volume":"54","author":"Fede","year":"2011","journal-title":"J Hepatol"},{"issue":"4","key":"2026082004023367100_luag218-B6","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1002\/hep.25573","article-title":"Adrenocortical dysfunction in liver disease: a systematic review","volume":"55","author":"Fede","year":"2012","journal-title":"Hepatology"},{"issue":"9","key":"2026082004023367100_luag218-B7","doi-asserted-by":"crossref","DOI":"10.1210\/jendso\/bvaf104","article-title":"Hypercalcemia of malignancy: mechanisms and therapeutic implications of concurrently elevated PTHrP and calcitriol","volume":"9","author":"Kometas","year":"2025","journal-title":"J Endocr Soc"},{"issue":"Supplement_1","key":"2026082004023367100_luag218-B8","doi-asserted-by":"crossref","DOI":"10.1210\/jendso\/bvae163.332","article-title":"6980 a case report of severe hypercalcemia in acute decompensated liver cirrhosis","volume":"8","author":"Mohamed Eid","year":"2024","journal-title":"J Endocr Soc"},{"issue":"10","key":"2026082004023367100_luag218-B9","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.eprac.2022.07.008","article-title":"Predictors of mortality in hypercalcemia of advanced chronic liver disease","volume":"28","author":"Majety","year":"2022","journal-title":"Endocr Pract"},{"issue":"2","key":"2026082004023367100_luag218-B10","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jceh.2020.05.004","article-title":"Idiopathic hypercalcemia in decompensated cirrhosis: reexploring an entity in oblivion","volume":"11","author":"Ragate","year":"2021","journal-title":"J Clin Exp Hepatol"}],"container-title":["JCEM Case 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