Wolfram syndrome (WS) is a recessive multisystem disorder defined by the association of diabetes mellitus and optic atrophy, reminiscent of mitochondrial diseases. The role played by mitochondria remains elusive, with contradictory results on the occurrence of mitochondrial dysfunction. We evaluated 13 recessive WS patients by deep clinical phenotyping, including optical coherence tomography (OCT), serum lactic acid at rest and after standardized exercise, brain Magnetic Resonance Imaging, and brain and muscle Magnetic Resonance Spectroscopy (MRS). Finally, we investigated mitochondrial bioenergetics, network morphology, and calcium handling in patient-derived fibroblasts. Our results do not support a primary mitochondrial dysfunction in WS patients, as suggested by MRS studies, OCT pattern of retinal nerve fiber layer loss, and, in fibroblasts, by mitochondrial bioenergetics and network morphology results. However, we clearly found calcium mishandling between endoplasmic reticulum (ER) and mitochondria, which, under specific metabolic conditions of increased energy requirements and in selected tissue or cell types, may turn into a secondary mitochondrial dysfunction. Critically, we showed that Wolframin (WFS1) protein is enriched at mitochondrial-associated ER membranes and that in patient-derived fibroblasts WFS1 protein is completely absent. These findings support a loss-of-function pathogenic mechanism for missense mutations in WFS1, ultimately leading to defective calcium influx within mitochondria. Wolfram Syndrome (WS) is a rare genetic disorder also known as DIDMOAD, i.e. Diabetes Insipidus (DI), Diabetes Mellitus (DM), Optic Atrophy (OA) and Deafness 1. Additional neurological features include brainstem atrophy, cerebellar ataxia, peripheral neuropathy, cognitive deterioration and epilepsy 2. The onset of OA and DM, the minimal diagnostic criteria for WS, is typically within the second decade. The large majority of WS patients carry recessive mutations in the WFS1 gene encoding for the Wolframin (WFS1) protein 3. WFS1 is associated with the endoplasmic reticulum (ER) 4 and cellular and animal model studies involved Wolframin in the ER stress response, regulation of calcium homeostasis and Na/K ATPase function 5. Due to the clinical features resembling a mitochondrial disorder 6 and reports of mitochondrial DNA (mtDNA)