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Alsaleh Y, Al Ghadeer HA, Aljabri A, Alhashim Z, Mohamed M, Busaleh F, Alramadhan FA, Alghazal MM. Pseudohypoaldosteronism Type 1B and Cohen Syndrome: Novel Mutation, Unusual Combination, and Presentation. Cureus 2024; 16:e57217. [PMID: 38681476 PMCID: PMC11056278 DOI: 10.7759/cureus.57217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/01/2024] Open
Abstract
Pseudohypoaldosteronism type 1 (PHA1) is a rare inherited disorder of resistance to aldosterone and presents with hyponatremia, hyperkalemia, and metabolic acidosis. Cohen syndrome (CS) is another rare inherited disease. Concurrent presentation with pseudohypoaldosteronism makes it so extraordinary and implies more challenges for clinicians. We report a case of a female with Cohen syndrome (novel mutation) and systemic pseudohypoaldosteronism, as well as the challenges we have encountered in the management of this patient.
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Affiliation(s)
- Yassin Alsaleh
- Endocrinology and Diabetes, Maternity and Children's Hospital, Al-Ahsa, SAU
| | | | - Aida Aljabri
- Endocrinology and Diabetes, Almoosa Specialist Hospital, Al-Ahsa, SAU
| | - Zahra Alhashim
- Endocrinology and Diabetes, King Faisal General Hospital, Al-Ahsa, SAU
| | - Moneera Mohamed
- Endocrinology and Diabetes, Maternity and Children's Hospital, Al-Ahsa, SAU
| | - Fadi Busaleh
- Pediatrics, Maternity and Children's Hospital, Al-Ahsa, SAU
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2
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Hanukoglu A, Vargas-Poussou R, Landau Z, Yosovich K, Hureaux M, Zennaro MC. Renin-aldosterone system evaluation over four decades in an extended family with autosomal dominant pseudohypoaldosteronism due to a deletion in the NR3C2 gene. J Steroid Biochem Mol Biol 2020; 204:105755. [PMID: 33017655 DOI: 10.1016/j.jsbmb.2020.105755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
Renal pseudohypoaldosteronism (PHA1) is a mild form of an aldosterone-resistance syndrome caused by mutations in the NR3C2 gene that codes for the mineralocorticoid receptor (MR). The disease is inherited as an autosomal dominant trait characterized by signs and symptoms of salt-losing in infancy. Disease manifestations could be severe in infancy but improve after the age of 1-3 years. Some affected members are asymptomatic and remain so life-long. In this study, we report the identification of a large deletion in the NR3C2 gene (c.1897+1_1898-1)_(c.*2955+?)del in renal PHA1 patients from an extended family spanning four generations. We prospectively evaluated the plasma renin activity and serum aldosterone profiles over four decades in symptomatic and asymptomatic affected family members. The benefits of early diagnosis on the clinical outcome were assessed as well. The long-term follow-up showed an age-dependent decrease in both plasma renin activity and serum aldosterone levels over the years. However, aldosterone levels remain high life-long. Thus, levels of aldosterone are a reliable marker to detect asymptomatic family members. The diagnosis of the proposita led to early diagnosis and therapy in other affected family members, significantly mitigating the clinical course. Despite the extremely elevated serum aldosterone levels during pregnancy, affected pregnant women did not experience any ill effects. However, this should be verified by observations in other adult patients.
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Affiliation(s)
- Aaron Hanukoglu
- Division of Pediatric Endocrinology, E. Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Rosa Vargas-Poussou
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France; Centre de Références de Maladies Rénales Rares de l'Enfant et d'Adulte (MARHEA)
| | - Zohar Landau
- Division of Pediatric Endocrinology, E. Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Keren Yosovich
- Molecular Genetics Lab, Wolfson Medical Center, Holon, Israel
| | - Marguerite Hureaux
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France; Inserm, PARCC, Université de Paris, F-75015 Paris, France
| | - Maria-Christina Zennaro
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France; Inserm, PARCC, Université de Paris, F-75015 Paris, France
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Goda T, Komatsu H, Nozu K, Nakajima H. An infantile case of pseudohypoaldosteronism type 1 (PHA1) caused by a novel mutation of NR3C2. Clin Pediatr Endocrinol 2020; 29:127-130. [PMID: 32694891 PMCID: PMC7348633 DOI: 10.1297/cpe.29.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Takeshi Goda
- Department of Pediatrics, Kyoto Chubu Medical Center, Kyoto, Japan.,Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Hiroshi Komatsu
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hisakazu Nakajima
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan.,Department of Pediatrics, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan
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Yakubov R, Ayman A, Kremer AK, van den Akker M. One-month-old girl presenting with pseudohypoaldosteronism leading to the diagnosis of CDK13-related disorder: a case report and review of the literature. J Med Case Rep 2019; 13:386. [PMID: 31883531 PMCID: PMC6935476 DOI: 10.1186/s13256-019-2319-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/20/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND It is not uncommon that an infant with a disease of unknown etiology is presented to a physician. Facial dysmorphic features lead to a different diagnosis. It is a challenge to link the presentation to the newfound diagnosis. CASE PRESENTATION A 37-day-old Yemenite Jewish girl was presented to our institution with a clinical picture of pseudohypoaldosteronism due to abnormal facial features and a psychomotor developmental delay. Further investigation led to the diagnosis of CDK13-related disorder. According to the literature, CDK13 has a key role in the cell cycle, but no interference with the aldosterone signaling pathway or electrolyte balance was described. No mutations in the previously described gene NR3C2 (cytogenetic location 4q31.23), encoding the mineralocorticoid receptor, were found. Although the clinical presentation corresponded to pseudohypoaldosteronism type 1, we could not genetically confirm this. CONCLUSIONS Probably pseudohypoaldosteronism was a coincidental finding in this girl with a CDK13 mutation, but because only limited information is known about CDK13-related disorders, further investigation could be more informative to clarify this presentation.
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Affiliation(s)
- Renata Yakubov
- Department of Pediatrics, Nephrology Unit, Hillel Yaffe Medical Center, Ha-Shalom Street, 38100, Hadera, Israel.
| | - Asaly Ayman
- Department of Pediatrics, Nephrology Unit, Hillel Yaffe Medical Center, Ha-Shalom Street, 38100, Hadera, Israel
| | - Adi Klein Kremer
- Department of Pediatrics, Nephrology Unit, Hillel Yaffe Medical Center, Ha-Shalom Street, 38100, Hadera, Israel
| | - Machiel van den Akker
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium.,Department of Pediatric Hematology Oncology, UZ Brussel, Brussels, Belgium
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Gopal-Kothandapani JS, Doshi AB, Smith K, Christian M, Mushtaq T, Banerjee I, Padidela R, Ramakrishnan R, Owen C, Cheetham T, Dimitri P. Phenotypic diversity and correlation with the genotypes of pseudohypoaldosteronism type 1. J Pediatr Endocrinol Metab 2019; 32:959-967. [PMID: 31301676 DOI: 10.1515/jpem-2018-0538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/27/2019] [Indexed: 12/27/2022]
Abstract
Background Type I pseudohypoaldosteronism (PHA1) is a rare condition characterised by profound salt wasting, hyperkalaemia and metabolic acidosis due to renal tubular resistance to aldosterone (PHA1a) or defective sodium epithelial channels (PHA1b or systemic PHA). Our aim was to review the clinical presentation related to the genotype in patients with PHA1. Methods A questionnaire-based cross-sectional survey was undertaken through the British Society of Paediatric Endocrinology and Diabetes (BSPED) examining the clinical presentation and management of patients with genetically confirmed PHA1. We also reviewed previously reported patients where genotypic and phenotypic information were reported. Results Genetic confirmation was made in 12 patients with PHA1; four had PHA1a, including one novel mutation in NR3C2; eight had PHA1b, including three with novel mutations in SCNN1A and one novel mutation in SCNN1B. It was impossible to differentiate between types of PHA1 from early clinical presentation or the biochemical and hormonal profile. Patients presenting with missense mutations of SCNN1A and SCNN1B had a less marked rise in serum aldosterone suggesting preservation in sodium epithelial channel function. Conclusions We advocate early genetic testing in patients with presumed PHA1, given the challenges in differentiating between patients with PHA1a and PHA1b. Clinical course differs between patients with NR3C2 and SCNN1A mutations with a poorer prognosis in those with multisystem PHA. There were no obvious genotype-phenotype correlations between mutations on the same gene in our cohort and others, although a lower serum aldosterone may suggest a missense mutation in SCNN1 in patients with PHA1b.
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Affiliation(s)
| | - Arpan B Doshi
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - Kath Smith
- Department of Genetics, Sheffield Children's Hospital, Sheffield, UK
| | - Martin Christian
- Department of Paediatric Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Talat Mushtaq
- Department of Paediatric Endocrinology, Leeds General Infirmary, Leeds, UK
| | - I Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Renuka Ramakrishnan
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool, UK
| | - Catherine Owen
- Department of Paediatric Endocrinology, The Newcastle Upon Tyne Hospitals and NHS Trust, Newcastle upon Tyne, UK
| | - Timothy Cheetham
- Department of Paediatric Endocrinology, The Newcastle Upon Tyne Hospitals and NHS Trust, Newcastle upon Tyne, UK
| | - Paul Dimitri
- Department of Paediatric Endocrinology, Sheffield Children's Hospital, Sheffield, UK.,Professor of Child Health and Consultant in Paediatric Endocrinology, The Department of Paediatric Endocrinology, The Academic Unit of Child Health, Damer St. Building, Sheffield Children's NHS Trust, Western Bank, Sheffield S10 2TH, UK
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Tanaka T, Oki E, Mori T, Tsuruga K, Sohara E, Uchida S, Tanaka H. Complete clinical resolution of a Japanese family with renal pseudohypoaldosteronism type 1 due to a novel NR3C2 mutation. Nephrology (Carlton) 2019; 24:489-490. [PMID: 30919533 DOI: 10.1111/nep.13391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Tatsuhiko Tanaka
- Department of Pediatrics, Hirosaki University Hospital, Aomori, Japan
| | - Eishin Oki
- Department of Pediatrics, Tsugaru General Hospital, Aomori, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazushi Tsuruga
- Department of Pediatrics, Hirosaki University Hospital, Aomori, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Pediatrics, Hirosaki University Hospital, Aomori, Japan.,Department of School Health Science, Hirosaki University Faculty of Education, Aomori, Japan
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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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Kawashima Sonoyama Y, Tajima T, Fujimoto M, Hasegawa A, Miyahara N, Nishimura R, Hashida Y, Hayashi A, Hanaki K, Kanzaki S. A novel frameshift mutation in NR3C2 leads to decreased expression of mineralocorticoid receptor: a family with renal pseudohypoaldosteronism type 1. Endocr J 2017; 64:83-90. [PMID: 27725360 DOI: 10.1507/endocrj.ej16-0280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pseudohypoaldosteronism type 1 (PHA1) is a rare genetic disease characterized by resistance to aldosterone, and the renal form of PHA1 is associated with heterozygous inactivating mutations in NR3C2, which encodes mineralocorticoid receptor (MR). Here we report a case of renal PHA1 due to a novel frameshift mutation in NR3C2. A 10-day-old Japanese male infant, born at 39 weeks gestation (birth weight, 2,946 g), was admitted to our hospital because of lethargy and vomiting, with a 6.7% weight loss since birth. Laboratory test results were: Na+, 132 mEq/L; K+, 6.6 mEq/L; Cl+, 93 mEq/L. Both plasma aldosterone level and plasma renin activity were markedly elevated at diagnosis, 2,940 ng/dL (normal range: 26.9-75.8 ng/dL) and 560 ng/mL/h (normal range 3.66-12.05 ng/mL/h), respectively. Direct sequence analysis of NR3C2 revealed a novel heterozygous mutation (c.3252delC) in the patient and his father. The mutation causes a frameshift starting at amino acid I 963 within the C terminal ligand-binding domain of MR and results in a putative abnormal stop codon at amino acid 994, with an extension of 10 amino acids compared to normal MR. We performed cell culture experiments to determine the levels of mutant NR3C2 mRNA and MR, and evaluate the effects of the mutation on MR response to aldosterone. The mutation decreased the expression of MR, but not NR3C2 mRNA, and led to decreased MR function, with no dominant negative effect. These results provide important information about MR function and NR3C2 mutation in PHA1.
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Affiliation(s)
- Yuki Kawashima Sonoyama
- Division of Pediatrics & Perinatology, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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Morikawa S, Komatsu N, Sakata S, Nakamura-Utsunomiya A, Okada S, Tajima T. Two Japanese patients with the renal form of pseudohypoaldosteronism type 1 caused by mutations of NR3C2. Clin Pediatr Endocrinol 2015; 24:135-8. [PMID: 26594094 PMCID: PMC4639533 DOI: 10.1297/cpe.24.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/01/2015] [Indexed: 11/27/2022] Open
Abstract
Pseudohypoaldosteronism type 1 (PHA1) is a disease characterized by neonatal salt loss
due to aldosterone resistance. Two types of PHA1 are known: an autosomal recessive
systemic form and an autosomal dominant renal form. The cause of the renal form of PHA1 is
heterozygous mutations in NR3C2, which encodes the mineralocorticoid
receptor (MR). We encountered two female Japanese infants with the renal form of PHA1 and
analyzed NR3C2. The two patients had poor weight gain, and one was
developmentally delayed. Genetic analysis identified one novel mutation (c.492_493insTT,
p.Met166LeufsX8) and one previously reported mutation (p.R861X). The two produced a
premature stop codon, resulting in haploinsufficiency of the MR. In conclusion, genetic
analysis of NR3C2 is useful for diagnosis and planning therapeutic
strategies.
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Affiliation(s)
- Shuntaro Morikawa
- Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan
| | - Nagisa Komatsu
- Department of Pediatrics, Japanese Red Cross Hospital Kumamoto, Kumamoto, Japan
| | - Sonoko Sakata
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Akari Nakamura-Utsunomiya
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Satoshi Okada
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Toshihiro Tajima
- Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan
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Rajpoot SK, Maggi C, Bhangoo A. Pseudohypoaldosteronism in a neonate presenting as life-threatening arrhythmia. Endocrinol Diabetes Metab Case Rep 2014; 2014:130077. [PMID: 24688761 PMCID: PMC3969520 DOI: 10.1530/edm-13-0077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/04/2014] [Indexed: 12/20/2022] Open
Abstract
Neonatal hyperkalemia and hyponatremia are medical conditions that require an emergent diagnosis and treatment to avoid morbidity and mortality. Here, we describe the case of a 10-day-old female baby presenting with life-threatening hyperkalemia, hyponatremia, and metabolic acidosis diagnosed as autosomal dominant pseudohypoaldosteronism type 1 (PHA1). This report aims to recognize that PHA1 may present with a life-threatening arrhythmia due to severe hyperkalemia and describes the management of such cases in neonates.
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Affiliation(s)
| | - Carlos Maggi
- Pediatric Intensive Care, Miller Children's Hospital Long Beach, California USA
| | - Amrit Bhangoo
- Children Hospital of Orange County 1201 W. La Veta Ave, Orange, California 92868 USA
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