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Goshima K, Tamura H, Hidaka Y, Furuie K, Kuraoka S. A case of secondary pseudohypoaldosteronism that presented as poor weight gain. Clin Case Rep 2024; 12:e8722. [PMID: 38562574 PMCID: PMC10982118 DOI: 10.1002/ccr3.8722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
Key clinical message Pseudohypoaldosteronism (PHA) carries a good prognosis if treated early and appropriately, but some cases can have life-threatening events. We underscored the need to consider secondary PHA as one of the differential diagnoses of hyponatremia and hyperkalemia in infancy. Abstract Pseudohypoaldosteronism (PHA) type 1 has two classifications; the primary type, caused by genetic abnormalities that develop during neonatal and infancy periods, and the secondary type, caused by urinary tract malformation and urinary tract infection. Secondary PHA, if treated early and appropriately, has a good prognosis; however, some cases can present life-threatening events. Therefore, early diagnosis is crucial. We present a case of early infancy secondary PHA presented with marked hyponatremia and poor weight gain. The patient's growth and development improved with secondary PHA treatment. Here, were demonstrated the value of prompt action against infection and electrolyte imbalance and the importance of imaging for diagnosis, and underscore the need to consider secondary PHA as a differential diagnoses of hyponatremia and hyperkalemia in infancy. However further studies, including basic research, to elucidate the diseases pathology is warranted.
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Affiliation(s)
- Keisuke Goshima
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Hiroshi Tamura
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Yuko Hidaka
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Keishiro Furuie
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Shohei Kuraoka
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
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Carl C, Dinkelbach L, Mohr J, Perez R, Vera Lopez T, Fricke-Otto S, Niehues T. Case report: Life threatening hyponatremia in infants with urinary tract infections: two cases of type III pseudohypoaldosteronism and review of the literature. Front Pediatr 2024; 11:1233205. [PMID: 38250595 PMCID: PMC10797885 DOI: 10.3389/fped.2023.1233205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
We describe two female infants at the age of five and six months with urinary tract infections presenting with vomiting and reduced drinking behavior. On laboratory analysis, severe hyponatremia (106 mmol/L and 109 mmol/L) was seen with hyperkalemia and compensated metabolic acidosis. Endocrinological analyses revealed massively increased levels of aldosterone and renin, leading to the diagnosis of type III pseudohypoaldosteronism (PHA). A review of the current literature 2013-2023 revealed 26 type III PHA cases aged up to ten months with reduced drinking behavior, weight loss and/or failure to thrive being the most common clinical presentations. Given the severe presentation of PHA electrolyte measurements in infants with urinary tract infections and/or in infants with congenital anomalies of the kidney and urinary tract (CAKUT) are strongly recommended.
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Affiliation(s)
- Cécile Carl
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
- Medical Faculty, RWTH University Aachen, Aachen, Germany
| | - Lars Dinkelbach
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Julia Mohr
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Ruy Perez
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Tobias Vera Lopez
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Susanne Fricke-Otto
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Tim Niehues
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
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Tuoheti Y, Zheng Y, Lu Y, Li M, Jin Y. Transient pseudohypoaldosteronism in infancy mainly manifested as poor appetite and vomiting: Two case reports and review of the literature. Front Pediatr 2022; 10:895647. [PMID: 36090572 PMCID: PMC9452901 DOI: 10.3389/fped.2022.895647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Transient Pseudohypoaldosteronism (TPHA) is a very rare condition usually secondary to urinary tract malformations (UTM) and/or urinary tract infection (UTI). It is characterized by hyperkalemia, hyponatremia, metabolic acidosis, and elevated plasma aldosterone levels. Given that the predominant manifestations of TPHA patients are digestive tract symptoms, such as poor appetite, vomiting, and weight gain, it is easily misdiagnosed as digestive tract diseases. CASE REPORTS Two children with poor appetite and vomiting were admitted to the Department of Gastroenterology, Children's Hospital of Nanjing Medical University, from 2020 to 2021. Laboratory test results of these two children revealed hyponatremia (< 135.00 mmol/L), hyperkalemia (> 5.50 mmol/L), and hyperaldosteronism (> 180.00 ng/L). Moreover, genetic tests demonstrated no genetic variants highly associated with the phenotype in both cases. The two patients were subsequently treated with electrolyte correction. One of them also treated with antibiotics and one of them underwent surgery. They were followed for 8 and 4 months, respectively. No complications were observed during the follow-up period. This review aimed to outline both cases with parental consent. CONCLUSION Transient pseudohypoaldosteronism should be considered in children younger than 6 months, presenting with vomiting, poor appetite, unexplained hyponatremia, hyperkalemia, elevated aldosterone levels, and urethral malformation or urinary tract infection. Furthermore, attention should be paid to whether salt supplementation or anti-infection therapy is effective.
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Affiliation(s)
- Yueerlanmu Tuoheti
- Medical School of Nanjing University, Nanjing, China.,Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yucan Zheng
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Lu
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Li
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Jin
- Medical School of Nanjing University, Nanjing, China.,Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Morisaki A, Naruse Y, Shibata Y, Mori M, Hiramoto R. Transient Pseudohypoaldosteronism Secondary to Group B Streptococcus Pyelonephritis. Cureus 2021; 13:e15071. [PMID: 34026387 PMCID: PMC8133509 DOI: 10.7759/cureus.15071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Secondary pseudohypoaldosteronism is a condition characterized by aldosterone resistance in renal tubules. It is highly associated with urinary tract infection and urinary tract malformations. Only a few cases of pseudohypoaldosteronism secondary to group B Streptococcus pyelonephritis have been reported to date. A four-month-old boy developed poor sucking and weight loss, and his laboratory test results revealed hyponatremia, hyperkalemia, renal dysfunction, high anion gap metabolic acidosis, pyuria, and hydronephrosis. Laboratory tests including urinalysis confirmed the diagnosis of pseudohypoaldosteronism secondary to group B Streptococcus. He was treated with intravenous normal saline and antimicrobial therapy. Electrolyte disorders were addressed and he was discharged on the 10th day of hospitalization without any sequelae. Voiding cystourethrography performed after discharge showed bilateral grade 5 vesicoureteral reflux and intrarenal reflux in the right kidney. Transient pseudohypoaldosteronism is an important consideration in the differential diagnosis in infants with hyponatremia and hyperkalemia. A thorough evaluation for urinary tract malformations should be performed, including early abdominal ultrasonography and systemic management.
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Affiliation(s)
- Atsuo Morisaki
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
| | - Yuki Naruse
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
| | - Yui Shibata
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
| | - Masato Mori
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
| | - Ryugo Hiramoto
- Pediatrics, Children Center, Matsudo City General Hospital, Matsudo, JPN
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Kaninde A, Grace ML, Joyce C, Taylor NF, Ghataore L, Riordan MF, O’Grady MJ, O’Connell SM. The incidence of transient infantile pseudohypoaldosteronism in Ireland: A prospective study. Acta Paediatr 2021; 110:1257-1263. [PMID: 33245792 DOI: 10.1111/apa.15688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/31/2020] [Accepted: 11/23/2020] [Indexed: 01/20/2023]
Abstract
AIM To review the clinical course, outcome and incidence of infantile salt wasting associated with urinary tract infection (UTI) and/or urinary tract malformation (UTM) over a two-year surveillance period on the island of Ireland. METHODS A two-year (2013-14) prospective surveillance undertaken via the Irish and Ulster Paediatric Surveillance Units. Monthly prepaid postcards were circulated to consultant paediatricians (n = 260) at all paediatric units on the island of Ireland. Infants under one year of age presenting for the first time with hyponatraemia (Na < 130 mmol/L) and/or hyperkalaemia (K > 5.0 mmol/L) associated with urosepsis/UTM were reported. RESULTS All 7 reported patients (6 male) had culture-proven UTI, and 5 (71%) also had an underlying UTM (one diagnosed antenatally). Four (57%) patients had a documented elevated serum aldosterone supporting secondary pseudohypoaldosteronism (PHA) as the underlying diagnosis. Data on aldosterone were not reported in the other 3 patients, but clinical features were suggestive of secondary PHA. The estimated incidence for the Irish population of transient PHA is 1 per 13,200 total live births per year. CONCLUSIONS Salt wasting is a rare complication of UTI, especially if associated with underlying UTM. Boys appear to be at particular risk.
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Affiliation(s)
| | - Mariana L. Grace
- Department of Paediatrics and Child Health Cork University Hospital Cork Ireland
| | - Caroline Joyce
- Department of Clinical Biochemistry Cork University Hospital Cork Ireland
| | - Norman F. Taylor
- Department of Clinical Biochemistry King’s College London London UK
| | - Lea Ghataore
- Principal Clinical Scientist Department of Biochemistry King’s College London London UK
| | - Micheal F. Riordan
- Department of Paediatric Endocrinologist Children’s Health Ireland at Crumlin Dublin Ireland
| | - Michael J. O’Grady
- Department of Paediatrics Regional Hospital Mullingar Co Westmeath Ireland
| | - Susan M. O’Connell
- Department of Paediatric Endocrinologist Children’s Health Ireland at Crumlin Dublin Ireland
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Delforge X, Kongolo G, Cauliez A, Braun K, Haraux E, Buisson P. Transient pseudohypoaldosteronism: a potentially severe condition affecting infants with urinary tract malformation. J Pediatr Urol 2019; 15:265.e1-265.e7. [PMID: 30962012 DOI: 10.1016/j.jpurol.2019.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/01/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Secondary pseudohypoaldosteronism (S-PHA) is a life-threatening condition affecting young children with urinary tract malformation (UTM). OBJECTIVE The aim of the study was to highlight the diagnosis of S-PHA in children with UTM and propose appropriate management. STUDY DESIGN The authors retrospectively reviewed cases of S-PHA related to UTM observed at the institution and searched the PubMed® database to review the literature. RESULTS A total of 116 cases of S-PHA associated with UTM, including the four cases from the institution, were reviewed. One hundred six cases (92.2%) were younger than 6 months, and 95 cases (81.9%) occurred in boys. Urinary tract infection was associated in 105 cases (90.5%). All types of UTM were observed. In the absence of urinary tract infection, S-PHA was related to bilateral UTM or solitary kidney. In 89 cases (76.5%), S-PHA resolved with medical treatment only. In cases of UTM requiring immediate surgery, electrolyte imbalance related to S-PHA also resolved after surgery. Children with associated urinary tract infection and bilateral UTM are at higher risk of developing S-PHA. DISCUSSION The pathogenesis of S-PHA has not been fully elucidated. Renal tubular immaturity may be one of the factors involved, in view of the young age of the population being affected. A high rate of bilateral UTM (or UTM on solitary kidney) was observed (50.9%), suggesting an association with S-PHA. In the absence of urinary tract infection (UTI), S-PHA appeared to occur more frequently in the presence of bilateral UTM. Although the indication for early surgery remains unclear, it may have a role in the prevention of UTI and prevention of recurrence of S-PHA. Serum electrolytes should be checked in children with UTM before urological surgery, and/or presenting urinary tract infection, before the age of 6 months. The results of this study must be interpreted cautiously because of its retrospective nature and the fact that data were derived from various articles. Few articles on S-PHA related to UTM have been published in the literature. To the best of the authors' knowledge, the study constitutes the largest series published to date. CONCLUSIONS S-PHA results in potentially severe electrolyte imbalance and affects children younger than 6 months with UTI and/or UTM. Electrolyte abnormalities related to S-PHA often resolve after administration of appropriate intravenous electrolyte solution and treatment of UTI and/or surgery.
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Affiliation(s)
- X Delforge
- Department of Pediatric Urology, CHU Amiens, France.
| | - G Kongolo
- Department of Pediatric Intensive Care Unit, CHU Amiens, France
| | - A Cauliez
- Department of Pediatric Endocrinology, CHU Amiens, France
| | - K Braun
- Department of Pediatric Endocrinology, CHU Amiens, France
| | - E Haraux
- Department of Pediatric Urology, CHU Amiens, France
| | - P Buisson
- Department of Pediatric Urology, CHU Amiens, France
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Tajima T, Morikawa S, Nakamura A. Clinical features and molecular basis of pseudohypoaldosteronism type 1. Clin Pediatr Endocrinol 2017; 26:109-117. [PMID: 28804203 PMCID: PMC5537208 DOI: 10.1297/cpe.26.109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/25/2017] [Indexed: 12/17/2022] Open
Abstract
Pseudohypoaldosteronism (PHA) type 1 is a disease showing mineralocorticoid resistance in the kidney and/or other mineralocorticoid target tissues. Patients with PHA1 present very high plasma aldosterone and renin levels, but they develop excessive salt wasting. There are three types of PHA1. The systemic form of PHA1 is inherited in an autosomal recessive manner and causes severe life-long salt loss in multiple target tissues, such as sweat glands, salivary glands, the colonic epithelium, and the lung. In the systemic form of PHA1, life-long salt supplementation is necessary. The second type is the renal form, where aldosterone resistance is shown only in the kidney, and its inheritance is autosomal dominant. In the renal form of PHA1, salt supplementation generally becomes unnecessary by 1-3 yr of age. The third type is the secondary PHA1, which is strongly associated with urinary tract infections and/or urinary tract malformations. This review summarizes the clinical features and molecular basis of PHA1. Understanding of its pathogenesis can be helpful for the early diagnosis and clinical care of affected children with PHA1.
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Affiliation(s)
- Toshihiro Tajima
- Department of Pediatrics, Jichi Children's Hospital Medical Center Tochigi, Tochigi, Japan
| | - Shuntaro Morikawa
- Department of Pediatrics, Hokkaido University School of Medicine, Hokkaido, Japan
| | - Akie Nakamura
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
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Abraham MB, Larkins N, Choong CS, Shetty VB. Transient pseudohypoaldosteronism in infancy secondary to urinary tract infection. J Paediatr Child Health 2017; 53:458-463. [PMID: 28233358 DOI: 10.1111/jpc.13481] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 11/03/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
Abstract
AIM Hyponatraemia with hyperkalaemia in infancy is a typical presentation of congenital adrenal hyperplasia. In the presence of pyelonephritis, the same biochemical picture can occur with transient type 1 pseudohypoaldosteronism (PHA-1) also termed type 4 renal tubular acidosis. Recognition of PHA-1 enables appropriate management thus avoiding unnecessary investigations and treatment. To improve awareness of this condition, we present a case series to highlight the clinical and biochemical features of PHA-1. METHODS A retrospective chart review of patients diagnosed with transient PHA-1 at a tertiary children's hospital in Western Australia was conducted. RESULTS Five male infants (32 days to 6 months) with transient PHA-1 were identified. Failure to thrive was the most common symptom with hyponatraemia on presentation. Two infants had antenatally diagnosed bilateral hydronephrosis and urinary tract infection (UTI) on admission. Two infants were treated for congenital adrenal hyperplasia and received hydrocortisone. All infants had UTI and required parenteral antibiotics. The condition was transient and hyponatraemia corrected by day 4 in all infants. There was no correlation between plasma sodium and aldosterone levels. The severity of PHA-1 was independent of the underlying renal anomaly. Four infants had hydronephrosis and vesicoureteric reflux. Surgical intervention was required in two infants. CONCLUSIONS PHA-1 may be precipitated by UTI or urinary tract anomalies in early infancy. Urine analysis should be performed in infants with hyponatraemia. Diagnosis of PHA-1 facilitates appropriate renal investigations to reduce long-term morbidity.
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Affiliation(s)
- Mary B Abraham
- Department of Endocrinology and Diabetes, The University of Western Australia, Perth, Western Australia, Australia.,School of Child Health and Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Nicholas Larkins
- Department of Nephrology, Princess Margaret Hospital, The University of Western Australia, Perth, Western Australia, Australia
| | - Catherine S Choong
- Department of Endocrinology and Diabetes, The University of Western Australia, Perth, Western Australia, Australia.,School of Child Health and Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Vinutha B Shetty
- Department of Endocrinology and Diabetes, The University of Western Australia, Perth, Western Australia, Australia.,School of Child Health and Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
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