title: Hypercalcemia in a patient with cholangiocarcinoma: a case report.
abstract: BACKGROUND
  Humoral hypercalcemia of malignancy is rarely associated with cholangiocarcinoma (CC).
  
  
  METHODS
  A 77-year-old man was admitted with confusion. Computer tomography showed a large multinodular mass in the right lobe of the liver and smaller lesions in the right lung. Liver histology confirmed the diagnosis of CC. Elevated calcium levels and suppressed intact parathyroid hormone in the absence of skeletal metastases or parathyroid gland pathology suggested the diagnosis of humoral hypercalcemia of malignancy (HHM). Treatment of hypercalcemia with saline infusion, loop diuretics, biphosphonate and calcitonin was effective in normalizing calcium levels and consciousness state within 48 hours, but a relapse occurred 4 weeks later and the patient succumbed to his disease.
  
  
  CONCLUSIONS
  Clinicians should be aware of this rare manifestation of CC as prompt and aggressive correction of hypercalcemia alleviates symptoms and improves patient's quality of life, despite the poor overall prognosis.
authors.affiliation: Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Greece. jxynos@hotmail.com
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Xynos
authors.forename: Stavros
authors.initials: S
authors.lastname: Sougioultzis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Zilos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Evangelou
authors.forename: Gregorios S
authors.initials: GS
authors.lastname: Hatzis