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Lim M, Gannon D. Diagnosis and outpatient management of Gitelman syndrome from the first trimester of pregnancy. BMJ Case Rep 2021; 14:14/5/e241756. [PMID: 33980557 PMCID: PMC8118020 DOI: 10.1136/bcr-2021-241756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A 32-year-old woman presented with an incidental finding of hypokalaemia on routine bloods at 9 weeks of a second pregnancy, on a background of lifelong salt craving. Her previous pregnancy was uncomplicated. She had no previous significant medical or family history. Venous blood gases showed a hypokalaemic, normochloraemic metabolic alkalosis. Urinary potassium was elevated. Escalating doses of oral supplementation of potassium, magnesium, sodium and potassium-sparing diuretics were required through the course of pregnancy, in response to regular electrolyte monitoring. These were later weaned and completely stopped post partum. Delivery was uneventful with no maternal or neonatal complications. Genetic testing performed post partum showed heterogenous mutation of SCL12A3 gene.
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Affiliation(s)
- Marie Lim
- Colchester General Hospital, Colchester, UK
| | - David Gannon
- Emergency Admission Unit, Colchester General Hospital, Colchester, UK
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2
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Zhang L, Peng X, Zhao B, Zhu Z, Wang Y, Tian D, Yan Z, Yao L, Liu J, Qiu L, Xing X, Chen L. Clinical and laboratory features of female Gitelman syndrome and the pregnancy outcomes in a Chinese cohort. Nephrology (Carlton) 2020; 25:749-757. [PMID: 32542819 DOI: 10.1111/nep.13743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
Abstract
AIM Gitelman syndrome (GS) is a rare inherited salt-losing renal tubulopathy. Data on clinical features and the pregnancy outcome for female GS patients in a large cohort are lacking. The study was aimed to explore the phenotype and pregnant issue for female GS patients. METHODS GS cases from the National Rare Diseases Registry System of China (NRSC) were collected, and detailed clinical, laboratory and genetic data were analysed. Articles on pregnancy in GS were also systemically reviewed. RESULTS A total of 101 GS patients were included; among them, 42.6% were female and 79.2% showed hypomagnesaemia. A lower proportion of female patients presented before 18 years of age, with less frequently reported polyuria, higher serum potassium and less urine sodium and chloride excretions. There was no gender difference in the sodium-chloride cotransporter (NCC) dysfunction evaluated by hydrochlorothiazide test. Twelve of the 43 female GS patients delivered after disease symptom onset, and their pregnancies were generally uneventful. As a group, pregnant GS patients had lower potassium levels in the first-trimester (P = .002) requiring higher potassium supplementation. After delivery, serum potassium (P = .02) and magnesium (P = .03) increased significantly. Both caesarean section and vaginal delivery were safe. CONCLUSION Female GS patients may have a less severe phenotype with generally favourable outcomes of pregnancy. Intensive monitoring and increased potassium supplementation are necessary during pregnancy, especially in the first-trimester.
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Affiliation(s)
- Lei Zhang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyan Peng
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bingbin Zhao
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhifeng Zhu
- Department of Endocrinology, Inner Mongolia Medical College Affiliated Hospital, Hohhot, China
| | - Ying Wang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongli Tian
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhaoli Yan
- Department of Endocrinology, Inner Mongolia Medical College Affiliated Hospital, Hohhot, China
| | - Li Yao
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, China
| | - Juntao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Qiu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoping Xing
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Abstract
OBJECTIVE To evaluate maternal and fetal outcomes in women with Gitelman syndrome (GS). METHODS Retrospective analysis of the clinical data of five patients with the clinical diagnosis of GS during pregnancy, who were admitted to Beijing Shijitan Hospital, Capital Medical University between 2013 and 2019, was conducted. RESULTS Five women with GS during pregnancy who finally gave birth to a total of eight newborns have been included. Three cases were primiparas and two cases were multiparas. Two cases were diagnosed before pregnancy and three cases were diagnosed in first or second trimester. The primary treatment was oral or intravenous electrolytes supplement. Three patients delivered through the vagina, and shoulder dystocia occurred in one patient. Two patients delivered by cesarean section, with one because of symptom of limb weakness during the course of labor and the other owing to gestational diabetes with fetal macrosomia. Postpartum hemorrhage and urinary retention were not reported in these cases. In perinatal period all the infants had good outcome. The children, aged between six months and five years, were healthy and well-developed during follow-up. CONCLUSION The maternal and perinatal outcome is usually favorable. We should pay attention to electrolyte examination in the first trimester in order to diagnose and manage the GS efficiently. Well-controlled patients with Gitelman syndrome can deliver through the vagina.
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Affiliation(s)
- Jingfei Zhang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Feiran Liu
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jinghui Tu
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Wu WF, Pan M. The outcome of two pregnancies in a patient with Gitelman syndrome: case report and review of the literature. J Matern Fetal Neonatal Med 2019; 33:4171-4173. [PMID: 30922139 DOI: 10.1080/14767058.2019.1598359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of a 30-year-old woman who was first found to have a persistently low serum potassium level at 26 years of age during her first pregnancy. Genetic test of SLC12A3 confirmed Gitelman syndrome. The patient remained asymptomatic and had two deliveries following spontaneous labor. The first neonate died of heart failure due to cardiac abnormalities. The obstetric and neonatal outcome of the second pregnancy was good.
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Affiliation(s)
- Wei-Fang Wu
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mian Pan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Gitelman Syndrome: A Rare Cause of Seizure Disorder and a Systematic Review. Case Rep Med 2019; 2019:4204907. [PMID: 30867665 PMCID: PMC6379858 DOI: 10.1155/2019/4204907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/20/2018] [Accepted: 01/17/2019] [Indexed: 01/06/2023] Open
Abstract
Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal convoluted tubules, mimicking a thiazide-like tumor. It usually presents in late childhood or in teenage as nonspecific weakness, fatigability, polyuria, and polydipsia but very rarely with seizures. It is classically associated with hypokalemia, hypomagnesemia, hypocalciuria, hyperreninemia, and hyperaldosteronism. However, less frequently, it can present with normal magnesium levels. It is even rarer to find normomagnesemic patients of GS who develop seizures as the main complication since hypomagnesemia is considered the principal etiology of abnormal foci of seizure-related brain activity in GS cases. Interestingly, patients with GS are oftentimes diagnosed during pregnancy when the classic electrolyte pattern consistent with GS is noticed. Our case presents GS with normal serum magnesium in a patient, with seizures being the main clinical presentation. We also did a comprehensive literature review of 122 reported cases to show the prevalence of normal magnesium in GS cases and an overview of clinical and biochemical variability in GS. We suggest that further studies and in-depth analysis are required to understand the pathophysiology of seizures in GS patients with both normal and low magnesium levels.
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Elbouajaji K, Blanchier D, Pourrat O, Sarreau M. [Management of Gitelman syndrome during pregnancy reporting 12 cases]. Nephrol Ther 2018; 14:536-543. [PMID: 30309814 DOI: 10.1016/j.nephro.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/08/2018] [Accepted: 06/24/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Gitelman syndrome is a rare hereditary renal tubulopathy, responsable of hypokalemia and hypomagnesaemia-related ionic disorders, which management is poorly codified during pregnancy. We report 12 cases of pregnancies with Gitelman syndrome and we compare our data with those of literature. MATERIAL AND METHODS It is a report of 12 pregnancies in 5 patients with Gitelman syndrome between 2002 and 2016. Follow up and outcome of pregnancy, delivery modalities and maternal-fetal prognosis have been collected. RESULTS In our serie, maximum kaliemie observed was 3.4mmol/L, with an average potassium, over all pregnancies of 2.3mmol/L. Oral potassium and magnesium supplementation at the end of pregnancy were 8900mg/day and 460mg/day, respectively. There were no serious maternal complications. Two pregnancies were complicated by intrauterine growth retardation in a context of preeclampsia. There is a large disparity in the methods of anesthetic management of these patients. Materno-fetal prognosis at 1 month post-partum is good. CONCLUSION Gitelman syndrome is a rare pathology where there is a lack of homogeneity in management of pregnancy. Monitoring of monthly ionogram is necessary. The goal is to obtain stable, non-symptomatic kaliemias, which will never be standardized even in increasing treatment. The most important is to inform and detect situations at risk of decompensation, including vomiting or the use of certain anesthetics. In agreement with literature data, monitoring of fetal growth and the amount of amniotic fluid in the third trimester is still warranted. These pregnancies require the development of a common care in multidisciplinary consultation meeting.
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Affiliation(s)
- Karima Elbouajaji
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - Dominique Blanchier
- Service de néphrologie, CH d'Angoulême, Rond-point de Girac, 16000 Angoulême, France
| | - Olivier Pourrat
- Service de réanimation médicale, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - Mélie Sarreau
- Service de gynécologie obstétrique, CH d'Angoulême, Rond-point de Girac, 16000 Angoulême, France.
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Abstract
Hypomagnesaemia is common in pregnancy, particularly in developing countries and low-income communities. Despite the frequent therapeutic use of magnesium in pregnancy, and the evidence regarding the association of hypomagnesaemia with adverse pregnancy outcomes in animal studies, it remains unclear whether hypomagnesaemia is associated with complications in human pregnancy. Three case reports of pregnancies complicated by moderate-severe hypomagnesaemia are presented and magnesium physiology in pregnancy is discussed. The evidence as to whether hypomagnesaemia may represent a direct cause, a consequence of other disease processes or an epiphenomenon in adverse pregnancies outcomes is reviewed.
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Affiliation(s)
- Adam Morton
- Mater Hospital, Raymond Tce, Brisbane, Australia
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Two cases of successful pregnancy in patients with Gitelman's syndrome. Clin Nephrol 2018; 84:301-6. [PMID: 26109196 PMCID: PMC4776256 DOI: 10.5414/cn108526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 12/28/2022] Open
Abstract
Gitelman's syndrome (GS) is a distal convoluted tubule (DCT) defect clinically characterized by hypokalemic metabolic alkalosis. Pregnancy in women with GS often results in severe hypomagnesemia and hypokalemia. We report two cases of successful pregnancies, after previous fetal loss, in patients with GS managed with aggressive oral and intravenous electrolyte repletion. These cases illustrate increased potassium and magnesium requirements over the course of the pregnancies and are notable due to the high doses of electrolytes required. They also demonstrate the possibility of successful pregnancy outcomes with frequent laboratory monitoring and aggressive titration of electrolyte replacement either orally or intravenously to maintain appropriate serum levels necessary to provide a suitable environment for fetal development.
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Elkoundi A, Kartite N, Bensghir M, Doghmi N, Lalaoui SJ. Gitelman syndrome: a rare life-threatening case of hypokalemic paralysis mimicking Guillain-Barré syndrome during pregnancy and review of the literature. Clin Case Rep 2017; 5:1597-1603. [PMID: 29026553 PMCID: PMC5628240 DOI: 10.1002/ccr3.1122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/26/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022] Open
Abstract
In rare cases, patients with Gitelman syndrome may present with hypokalemic paralysis mimicking Guillain–Barré syndrome. The severity of resultant symptoms may be life‐threatening. Controversial drugs such as aldactone, amiloride, and eplerenone should be used in this situation despite the lack of safety data.
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Affiliation(s)
- Abdelghafour Elkoundi
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Noureddine Kartite
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Mustapha Bensghir
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Nawfal Doghmi
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Salim Jaafar Lalaoui
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
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Merhi B, Miller M, Lanis A, Katz B, Hsu T, Tong I. Management of uncommon disorders in pregnancy: Von Hippel-Lindau disease, Gitelman syndrome, and Nutcracker syndrome. Obstet Med 2016; 10:138-141. [PMID: 29051782 DOI: 10.1177/1753495x16683088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/09/2016] [Indexed: 01/10/2023] Open
Abstract
Uncommon renal disorders in pregnancy can be challenging to manage given limited evidence in the literature to guide management. We present a series of three uncommon renal disorders in pregnancy: Von Hippel-Lindau disease, Gitelman syndrome, and Nutcracker syndrome. Previously published case reports with differing outcomes offer some guidance to the management of these disorders in pregnancy. In this case series, we address the management of these syndromes during pregnancy and discuss the maternal and fetal outcomes. All three of our patients had good maternal and fetal outcomes, which will contribute to current data on maternal and fetal outcomes in these rare diseases, which is limited.
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Affiliation(s)
- Basma Merhi
- Division of Nephrology, Department of Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Margaret Miller
- Division of Obstetric Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Aviya Lanis
- Internal Medicine Residency Program, Santa Clara Valley Medical Centre, California, USA
| | - Brittany Katz
- Internal Medicine Residency Program, Santa Clara Valley Medical Centre, California, USA
| | - Tiffany Hsu
- Internal Medicine Residency Program, Santa Clara Valley Medical Centre, California, USA
| | - Iris Tong
- Division of General Internal Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, USA
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Mathen S, Venning M, Gillham J. Outpatient management of Gitelman's syndrome in pregnancy. BMJ Case Rep 2013; 2013:bcr-2012-007927. [PMID: 23355577 DOI: 10.1136/bcr-2012-007927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gitelman's syndrome is a congenital renal tubular defect which affects the apical membrane of the distal convoluted tubule of the renal system. The syndrome is characterised by hypokalaemia, hypomagnesaemia, metabolic alkalosis and hypocalcuria. There are only a few cases describing the impact of Gitelman's syndrome on pregnancy and the foetus. Although most pregnancies have favourable outcomes, fetal demise has been reported in the third trimester. We report the successful outcome of pregnancy in a patient with Gitelman's syndrome who continued on amiloride in pregnancy to optimise potassium and magnesium levels and review the literature for pregnancy outcomes of this condition.
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Affiliation(s)
- Stephy Mathen
- Department of Obstetrics and Gynaecology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK.
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12
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KWAN TK, FALK MC. Second pregnancy outcome in a patient with Gitelman syndrome without the use of parenteral electrolyte supplementation. Aust N Z J Obstet Gynaecol 2010; 51:94-5. [DOI: 10.1111/j.1479-828x.2010.01248.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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