Familial Hypocalciuric Hypocalcemia

To the Editor: We write out of serious concern for what we believe is an inappropriate recommendation of Marx et al. (August 12 issue)* that familial hypercalcemia with hypocalciuria, relative to urinary calcium levels in a majority of patients with hyperparathyroidism, essentially remain untreated. Admittedly, some controversy continues over whether this syndrome is legitimately any different from primary hyperparathyroidism presenting in a familial form. An autosomally dominant mode of transmission of hypercalcemia, inappropriately raised parathyroid hormone levels for a given degree of hypercalcemia, increased urinary cyclic AMP, and the induction of hypocalcemia after adequate removal of hyperplastic parathyroid tissue are.