Gitelman Syndrome in Pregnancy: A Clinical Challenge

Abstract

Purpose Disease progress may be affected by pregnancy-related changes, and underlying conditions may also affekt pregnancy outcomes in women with Gitelman syndrome (GS). Case presentation A 35-year-old woman with GS (gravida 2 para 1) was referred to our hospital to start routine antenatal care follow-up at 6 weeks of gestation. At the age of 31, she had been diagnosed with GS after her first uneventful pregnancy. Upon early admission, her serum Mg+level was 0.51 mmol/L and her serum K+level 2.7 mmol/L with normal kidney function tests. She was already taking oral combined potassium citrate and potassium bicarbonate supplementation once a day before pregnancy. At the eighth gestational week, the medication was changed to an oral potassium color sachet of 1.5 gram per day until labor because of the insufficient dosage to maintain optimum potassium levels. She was also taking 365 milligrams of oral magnesium oxide twice a day before and during pregnancy. In the third trimester of the pregnancy, her serum Mg+level was 0.48 mmol/L and serum K+level 2.8 mmol/L. Because of the previous uterine surgery history, she underwent an elective cesarean operation at 39 weeks’ gestation under spinal anesthesia and delivered a healthy 3090-gram female infant.

Conclusion Increased need for potassium and magnesium supplementation should be the critical considerations when managing pregnant patients with GS.

Gitelman syndrome - pregnancy - potassium

Publication History

Received: 11 February 2020

Accepted after revision: 19 April 2021

Article published online:
14 June 2021

• References

• 1 Gitelman H. A new familial disorder characterized by hypokalemia and hypomagnesemia. Trans Assoc Am Physicians 1966; 79: 221-235
• 2 Seyberth HW. An improved terminology and classification of Bartter-like syndromes. Nat Clin Pract Nephrol 2008; 4: 560-567
• 3 Melander O, Orho-Melander M, Bengtsson K. et al. Genetic variants of thiazide-sensitive NaCl-cotransporter in Gitelman’s syndrome and primary hypertension. Hypertension 2000; 36: 389-394
• 4 Tago N, Kokubo Y, Inamoto N. et al. A high prevalence of Gitelman’s syndrome mutations in Japanese. Hypertens Res 2004; 27: 327-331
• 5 Basu A, Dillon R, Taylor R. et al. Is normalisation of serum potassium and magnesium always necessary in Gitelman syndrome for a successful obstetric outcome?. BJOG 2004; 111: 630-634
• 6 Simon DB, Nelson-Williams C, Bia MJ. et al. Gitelman’s variant of Barter's syndrome, inherited hypokalaemic alkalosis, is caused by mutations in the thiazide-sensitive Na–Cl cotransporter. Nat. Gen 1996; 12: 24-30
• 7 Peters M, Jeck N, Reinalter S. et al. Clinical presentation of genetically defined patients with hypokalemic salt-losing tubulopathies. Am J Med 2002; 112: 183-190
• 8 Daskalakis G, Marinopoulos S, Mousiolis A. et al. Gitelman syndrome-associated severe hypokalemia and hypomagnesemia: case report and review of the literature. J Mat Fetal Neonatal Med 2010; 23: 1301-1304
• 9 Jones JM, Dorrell S. Outcome of 2 pregnancies in a patient with Gitelman's syndrome-a case report. J Matern Fetal Investig 1998; 8: 147-148
• 10 Talaulikar GS, Falk MC. Outcome of pregnancy in a patient with Gitelman syndrome: a case report. Nephron Physiology 2005; 101: 35-38
• 11 Ethier JH, Kamel KS, Magner PO. et al. The transtubular potassium concentration in patients with hypokalemia and hyperkalemia. Am J Kidney Dis 1990; 15: 309-315
• 12 Al Shibli A, Narchi H. Bartter and Gitelman syndromes: spectrum of clinical manifestations caused by different mutations. World J Methodol 2015; 5: 55-61
• 13 Wu W-F, Pan M. The outcome of 2 pregnancies in a patient with Gitelman syndrome: case report and review of the literature. J Matern Fetal Neonatal Med 2020; 33: 4171-4173 Epub 2019 Mar 28
• 14 Standley CA, Whitty JE, Mason BA. et al. Serum ionized magnesium levels in normal and preeclamptic gestation. Obstet Gynecol 1997; 89: 24-27
• 15 Calò LA, Caielli P. Gitelman’s syndrome and pregnancy: new potential pathophysiological influencing factors, therapeutic approach and materno-fetal outcome. J Matern Fetal Neonatal Med 2012; 25: 1511-1513
• 16 Waguespack DR, Kasekar R, Abdel-Kader K. et al. 2 cases of successful pregnancy in patients with Gitelman’s syndrome. Clin Nephrol 2015; 84: 301-306
• 17 Spätling L, Disch G, Classen HG. Magnesium in pregnant women and the newborn. Magnes Res 1989; 2: 271-280
• 18 Prentice A. Kalzium in pregnancy and lactation. Annu Rev Nutr 2000; 20: 249-272
• 19 Black RE. Micronutrients in pregnancy. Br J Nutr 2001; 85: S193-S197
• 20 Williams KP, Galerneau F. The role of serum uric acid as a prognostic indicator of the severity of maternal and fetal complications in hypertensive pregnancies. J Obstet Gynaecol Can 2002; 24: 628-632
• 21 Shanbhag S, Neil J, Howell C. Anaesthesia for caesarean section in a patient with Gitelman’s syndrome. Int J Obstet Anesth 2010; 19: 451-453
• 22 Silveira M, Haynes S. Bujanova J. Presentation, investigations and management of suspected Gitelman syndrome in pregnancy. Society for Endocrinology BES 2019: BioScientifica. 2019
• 23 de Haan J, Geers T, Berghout A. Gitelman syndrome in pregnancy. Int J Gynaecol Obstet 2008; 103: 69-71
• 24 Cruz DN, Shaer AJ, Bia MJ. et al. Gitelman’s syndrome revisited: an evaluation of symptoms and health-related quality of life. Kidney Int 2001; 59: 710-717
• 25 Almonte RA, Heath DL, Whitehall J. et al. Gestational magnesium deficiency is deleterious to fetal outcome. Biol Neonate 1999; 76: 26-32