Pseudohypoparathyroidism was initially suspected because of the characteristic habitus of truncal obesity, round facies, shortening of the fourth metatarsals, recurrent subcutaneous calcifications in the extremities, mental retardation with an IQ of 67, and biochemical abnormalities of hypocalcaemia (7 2 mg/100 ml (1 8 mmol/1); normal 9 0 to 11-5 mg/100 ml (2 25 to 2 87 mmol/l)), and hyperphosphataemia (9 7 mg/100 ml (3 13 mmol/l); normal 3 0 to 4 5 mg/l00 ml (0 97 to 1 45 mmol/l)). No eye abnormalities were noted on examination at that time. At the time of her diagnosis the patient was begun on supplemental vitamin D of 50 000 units per day. While she was on this regimen her serum calcium levels were found to be in the range of 8 to 10 mg/l00 ml (2 to 2 5 mmol/l), while her