A case of pseudohypoaldosteronism type 1 with a mutation in the mineralocorticoid receptor gene

Abstract

Pseudohypoaldosteronism type 1 (PHA1) is a rare form of mineralocorticoid resistance characterized in newborns by salt wasting with dehydration, hyperkalemia and failure to thrive. This disease is heterogeneous in etiology and includes autosomal dominant PHA1 owing to mutations of the NR3C2 gene encoding the mineralocorticoid receptor, autosomal recessive PHA1 due to mutations of the epithelial sodium channel (ENaC) gene, and secondary PHA1 associated with urinary tract diseases. Amongst these diseases, autosomal dominant PHA1 shows has manifestations restricted to renal tubules including a mild salt loss during infancy and that shows a gradual improvement with advancing age. Here, we report a neonatal case of PHA1 with a NR3C2 gene mutation (a heterozygous c.2146_2147insG in exon 5), in which the patient showed failure to thrive, hyponatremia, hyperkalemia, and elevated plasma renin and aldosterone levels. This is the first case of pseudohypoaldosteronism type 1 confirmed by genetic analysis in Korea.

Keywords: Infant; Mineralocorticoid; NR3C2 gene; Pseudohypoaldosteronism; Receptor.

Fig. 1

Partial sequencing data of the NR3C2 gene of the patient and his parents. The patient had a heterozygous c.2146_2147insG (p.E716GfsX28) mutation in exon 5 of the NR3C2 gene (panel A, 5'>3' sense sequences; panel B, 3'>5' complementary sequences). His parents (panel C, his mother; panel D, his father) did not have the insertion mutation.