In Reply.—We agree with Gaudelus and colleagues that rib cage deformity is an important clue for the diagnosis of neonatal hyperparathyroidism. The deformity also had a great influence on the outcome of our patient. We now report the rest of the clinical course of our patient and add some comments on the case.
After total parathyroidectomy, remineralization of the bones was observed roentgenographically, and the serum calcium level was maintained with administration of calcium and ergocalciferol. The maintenance dose of calcium and ergocalciferol was decreased gradually, and the patient no longer needed medication at the age of 5 months to maintain a normal serum calcium level. Laboratory examination showed the presence of parathyroid hormone in the patient's blood, and it was suspected that the patient had had more than four parathyroid glands or that a latent embryonic cell group with the potential for becoming parathyroid cells had been activated.