Gitelman Syndrome Presenting as Hypokalemic Periodic Paralysis: A Case Report

Jinal Shah *

Department of General Medicine, SBKS MI and RC, Dhiraj General Hospital, Sumandeep Vidyapeeth (Deemed to be University), Pipariya, Vadodara, Gujarat, India.

Prasen Shah

Department of General Medicine, SBKS MI and RC, Dhiraj General Hospital, Sumandeep Vidyapeeth (Deemed to be University), Pipariya, Vadodara, Gujarat, India.

Mahesh Gupta

Department of General Medicine, SBKS MI and RC, Dhiraj General Hospital, Sumandeep Vidyapeeth (Deemed to be University), Pipariya, Vadodara, Gujarat, India.

Naresh Shah

Department of General Medicine, SBKS MI and RC, Dhiraj General Hospital, Sumandeep Vidyapeeth (Deemed to be University), Pipariya, Vadodara, Gujarat, India.

*Author to whom correspondence should be addressed.


Abstract

Gitelman Symdrome is a type of inherited tubulopathy that results in hypokalemia, hypomagnesemia, hypocalciuria and metabolic alkalosis. It is generally due to loss of function mutation of SLC12A3 Gene. The prevalence is estimated at approximately 1:40,000. In the majority of cases, symptoms do not appear before the age of six years and the disease is usually diagnosed during adolescence or adulthood. Some patients experience severe fatigue interfering with daily activities, while others never complain of tiredness. The symptoms and severity can even vary among members of the same family. Blood pressure is lower than that in the general population. The prognosis of patients with Gitelman Syndrome is excellent, except the few patients may be at risk for Cardiac arrhythmias. Potassium and Magnesium depletion increases the risk of ventricular arrhythmia. Sudden cardiac arrest has been reported occasionally.. We describe case of a man in his early 40’s having severe hypokalemia but only mild muscular weakness. Patient did not have any neurological deficit. His tone, power (5/5 in all four limbs) and deep tendon reflexes (+2 in all four limbs) were absolutely normal.

Keywords: Hypokalemic periodic paralysis, Gitelman syndrome, inherited tubulopathy, metabolic alkalosis, hypomagnesemia, hypocalciuria


How to Cite

Shah , J., Shah , P., Gupta , M., & Shah , N. (2023). Gitelman Syndrome Presenting as Hypokalemic Periodic Paralysis: A Case Report. Asian Journal of Research in Nephrology, 6(1), 95–100. Retrieved from https://journalajrn.com/index.php/AJRN/article/view/67


References

Shaer AJ. Inherited primary renal tubular hypokalemic alkalosis: A review of gitelman and bartter syndromes. Am J Med Sci. 2001;322:316-332.

Bettinelli A, Bianchetti MG, Girardin E, et al. Use of calcium excretion values to distinguish two forms of primary renal tubular hypokalemic alkalosis: Bartter and Gitelman syndromes. J Pediatr. 1992;120: 38-43.

Comprehensive Clinical Nephrology, 3rd Edition, Chapter 46, p553-554.

Gitelman HJ, Graham JB, Welt LG. A new familial disorder characterized by hypokalemia and hypomagnesemia. Trans Assoc Am Physic. 1966;79:221-235.

Simon DB, Nelson-Williams C, Johnson Bia M, Ellison D, Karet FE, Morey Molina A, Vaara I, Iwata F, Cushner HM, Koolen M, Gainza FJ. Gitelman’s variant of Barter’s syndrome, inherited hypokalemic alkalosis, is caused by mutations in the thiazide sensitive Na-Cl cotransporter. Nature Genetics. 1996;12(1):24-30.

Knoers NV, Levtchenko EN. Gitelman Syndrome. Orphanet J Rare Dis. 2008;3: 22.

Simon DB, Lifton RJ. The molecular basis of inherited hypokalemic alkalosis: Bartter and Gitelman Syndromes. Am J Physiol. 1996;271:F961-F966.

Corbetta S, Raimondo F, Tedeschi S, et al. Urinary exosomes in the diagnosis of Gitelman and Bartter syndromes. Nephrol Dial Transplant. 2015;30(4):621-30.

Zelikovic I, Szargel R, Hawash A, et al. A novel mutation in the chloride channel gene, ClCKB, as a cause of Gitelman and Bartter syndromes. Kidney Int. 2003;63:24-32.

Schmidt H, Kabesch M, Schwarz HP, Kiess W. Clinical, biochemical and molecular genetic data in five children with Gitelman’s syndrome. Hormone and Metabolic Research. 2001;33(06):354-7.

Lee YT, Wang IF, Lin TH, Huang CT. Gitelman syndrome: Report of three cases and literature review. The Kaohsiung Journal of Medical Sciences. 2006;22(7): 357-62.

Blanchard A, Bockenhauer D, Bolignano D, et al. Gitelman syndrome: consensus and guidance from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies conference. Kidney Int. 2017;91(1):24-33.

Blanchard A, Vargas-Poussou R, Vallet M, et al. Indomethacin, amiloride, or eplerenone for treating hypokalemia in Gitelman syndrome. J Am Soc Nephrol. 2015;26(2):468-75.

Harrison’s Principles of Internal Medicine, 21st Edition. 1(53);351.

Matsunoshita N, Nozu K, Shono A, et al. Differential diagnosis of bartter syndrome, gitelman syndrome, and pseudo-bartter/gitelman syndrome based on clinical characteristics. Genet Med. 2016; 18(2):180-8.