Background: Calcium, the major inorganic component in bone, plays an important role in insulin secretion and insulin resistance. Insulin resistance is essential in the pathophysiology of non-alcoholic steatohepatitis (NASH), polycystic ovarian syndrome (PCOS), and Type 2 diabetes mellitus (DM). Case Presentation: We present a case of chronic asymptomatic hypercalcemia in an individual with NASH, PCOS, and DM. She was noted to have a serum calcium of 12.8 mg/dl and a homeostatic model assessment of insulin resistance (HOMA-IR) of 4.7 in the last 2 years. Almost all other causes of hypercalcemia were ruled out. The patient was treated conservatively and advised to avoid factors that can aggravate hypercalcemia. Conclusion: The insulin effect on calcium homeostasis is impaired in conditions of insulin resistance. There is increasing evidence of the association between hypercalcemia and insulin resistance. However, it remains a diagnosis of exclusion.

Keywords: Liver disease, hypercalcemia, non-alcoholic steatohepatitis, insulin resistance, diabetes mellitus