1 Veterans Administration Medical Center, 4435 Beacon Ave, Seattle, WA 98108
To the Editor.
The article by Griswold et al1 is useful in demonstrating again the toxicity of aluminum. Several points in the case report, however, demonstrate that a fair amount of information accumulated in adult nephrology may be unknown to pediatricians.
First, hypercalcemia is common with this form of osteomalacia.2-5 Second, the mild parathyroid hormone elevations in this patient were almost certainly due to retention of inactive parathyroid hormone metabolites as a result of renal insufficiency.6 The combination of hypercalcemia and minimal parathyroid hormone elevation led to an inappropriate, indeed hazardous parathyroidectomy.