CASE PRESENTATION: A 53-year-old female with past medical history of hypertension, type 2 diabetes mellitus and dyslipidemia presented with a 3-day history of generalized body weakness and 1-day history of vomiting, diffuse abdominal pain and altered metal status (AMS). Investigations revealed serum creatinine 3.7 mg/dL, calcium 16.7 µg/dL, amylase 678 U/L, lipase 912 U/L. Intact PTH levels of 23 pg/mL (normal), PTH related protein 49 pg/mL (elevated), Vitamin D 1,25 89 mg/dL (elevated), serum ACE level 175 U/Liter (elevated). CT chest showed diffuse mediastinal/subcarinal/hilar adenopathy. CT abdomen revealed enlarged pancreatic head. The patient was admitted with the impression of acute metabolic encephalopathy, severe pancreatitis and acute kidney injury all ascribed to severe hypercalcemia. She was started on aggressive intra venous fluid hydration and intravenous calcitonin after which the AMS resolved and hypercalcemia improved. Further work up for hypercalcemia with bronchoscopy guided FNA cytology from hilar lymphnodes revealed non caseating granuloma, suggestive of sarcoidosis. The patient was started on prednisone 20 mg po daily and serum calcium levels normalized.