This progression observed in these patients was probably caused both by the cumulative effects of intravenous calcium administration required in case of acute symptomatic hypocalcemia, the unphysiological nature of intermittent PTH replacement by multiple daily injections, the genetic background, notably in case of CaSR mutations with hypocalcemia associated with hypercalciuria and the progression of the disease. This evidence concerns the gene CASR and Hypocalcemia.