The investigation and management of patients presenting with hypercalcaemia is not always straightforward. We describe the case of a middleaged man presenting with severe symptomatic hypercalcaemia. The difficulties encountered here - in striving for biochemical and symptom control, and in establishing a definite diagnosis - are fortunately rare. The case illustrates the range of options in the treatment of severe hypercalcaemia, and highlights the use of haemodialysis in treatmentresistant cases.