Despite an emphasis on manipulative algebraic techniques in secondary school algebra, many tertiary mathematics students have mastered these skills without conceptual understanding. A significant number of students with high tertiary entrance ranks enrolled in first semester university mathematics were found to have misconceptions relating to pronumerals. School mathematics teaching at all levels must emphasise that pronumerals represent numbers, not objects, labels or abbreviations. Symbol manipulation must be balanced by problem-solving experiences so that the different roles of pronumerals either as variables, parameters, specific unknown numbers or generalised numbers have meaning for students.