Phenylketonuria (PKU; McKusick 261600) is one of the most common metabolic diseases among Caucasians, with median incidence of 1 in 10000 (Scriver et al 1995). This report presents the preliminary incidence and origin of PKU in Estonia, especially among Estonians, the genotype of our patients, and comparison of our results with those for other populations, particularly with Finno-Ugric populations. For a retrospective study all data on PKU patients born during 1980-1992 were collected. A total of 37 patients, 18 males and 19 females, in 35 families were determined. All these cases were late-diagnosed. All investigated cases can be classified as classical PKU, according to the initial phenylalanine (Phe) level before the treatment and Phe tolerance on diet. Data on the nationality and birthplaces of the parents and grandparents were collected by individual interview with each family. Molecular diagnosis of PKU was performed using exon-specific polymerase chain reaction (PCR) for amplifying exons with more numerous mutations, followed by sequencing or restriction analysis of the PCR product. In February 1993 a neonatal PKU screening programme was started in Estonia. A modified fluorimetric method for phenylalanine determination from filter-paper blood based on the enhancement of the fluorescence of a phenylalanine-ninhydrin reaction product by L-leucyl-L-atanine (McCaman and Robins 1962) is used. In total 33000 newborns have been tested for PKU and 6 cases of PKU have been diagnosed, giving a frequency of 1 in 5500. The analysis of the data for Estonia indicates a relatively high frequency of classical PKU, similar to that of middle-European countries and higher than in the other FinnoUgric populations, e.g. Finland 1 in 200000 and Hungary 1 in I 1000 (Scriver et al 1995). The present data show that in spite of linguistic and ethnic similarity with the Finns, Estonians are genetically rather different from them. Fifty-two per cent of our patients are at least third-generation Estonians. Other patients are mainly of Slavic origin. According to the data of the health authorities, 63.86% of our population are Estonians. Unfortunately, this figure was calculated according to parents' nationality (in only one generation). Of our so-called 'non-Estonian' group, 22% are families where only one grandparent is from another nationality and these patients were classified in the health register as Estonians. Therefore, it is difficult to compare these figures exactly. However, no considerable difference between the incidence of PKU among Estonians and other nationalities in Estonia has been found.