To the Editor.
—Gerhardt et al1 reported hypercalcemia of unknown origin in 16 patients with advanced liver disease. Unfortunately, the authors apparently did not study the status of the bone in those patients. The presence of hypercalcemia and total or partial suppression of parathyroid hormone secretion is one of the landmarks of the syndrome of aluminum intoxication. Although frequently observed in patients with renal failure, it can also occur in other conditions. We have reported aluminum intoxication in two patients with advanced liver disease and hypercalcemia.2 In one patient the diagnosis was made after a successful liver transplant. Correction of hypercalcemia and skeletal lesions occurred after treatment with deferoxamine.2,3Although reduced skeletal uptake in bone scans3 associated with hypercalcemia and partial or total parathyroid hormone suppression strongly suggests the possibility of aluminum intoxication, an undecalcified iliac crest bone biopsy with staining for aluminum is necessary for