Case Report

Systemic Pseudohypoaldosteronism Type I: A Case Report and Review of the Literature

Table 2

Compilation of clinical follow-up data of pseudohypoaldosteronism type I patients reported in the literature.

AuthorAge at follow-up (years)MutationSodium requirementKayexalate doseHeightWeightComments

Nur et al.5.4SCNN1A 1685 C>T
Missense
23 mEq/kg/day2.4 g/kg/day−1.5 SDS−3.1 SDSFrequent respiratory infections from age of 2 to 3 years, improved with increasing age.

Schaedel et al. [11]
Patient 49SCNN1A 1685C>T;
SCNN1A 1477 T>C;
SCNN1A 1449delC
Missense, compound heterozygous
NANANANAFrequent salt wasting episodes; constipation and gastric ulcer; infrequent respiratory symptoms.
Patient 12SCNN1A 1449delC
Frameshift, homozygous
NANANANARespiratory infections starting at 8 months.
Patient 38SCNN1A 729delA;
SCNN1A 1449delC
Frameshift, compound heterozygous
160 mEq/day [12]10 g/day [12]Short stature. [12]NARequires antibiotics (often IV) for respiratory symptoms q4–8 weeks; recurrent pseudomonas pneumonias. [12]

Dirlewanger et al. [13]0.5SCNN1A c.727T>C
Missense, homozygous
00NANABorn prematurely; transient PHA; able to discontinue salt supplementation at 6 months.
Sibling born at term with identical mutation but no symptoms.

Edelheit et al. [14]
Patient 448.3SCNN1A 1078G>T;
SCNN1A 1404delC
8 g/day0NANANo salt wasting episodes or respiratory tract infections after discharge at 4.5 months; Kayexalate discontinued at 15 months.
Patient TR20.4SCNN1A 1455delC
Frameshift, homozygous
3 g/day12 g/dayNANADeveloping normally.

Hanukoglu et al. [15]
Patient A11SCNN1A 327G>C;
SCNN1A His450fs
Compound heterozygous
8 g/dayNA0.4 SDS0.9 SDSNo salt wasting after age of 9 years; no respiratory symptoms.
Patient B20SCNN1A
Arg508 Stop, homozygous
15–20 g/dayNA−2.1 SDS0.4 SDSDecreased frequency and severity of salt wasting episodes and respiratory symptoms with age.
Patient C22.1No mutation found<10 g/dayNA−1.8 SDS−0.1 SDSNo severe salt wasting or respiratory infection requiring hospitalization in the past 7 years despite poor compliance.

Ekinci et al. [16]3.25SCNN1A c.684+2 T>A
Splice-site, homozygous
21.8 mEq/kg/day3.4 g/kg/day0 SDS+2 SDSNo respiratory problems or hospitalizations since neonatal period.

Dogan et al. [17]3.5SCNN1B c.1266-1G>C
Splice-site, homozygous
26 mEq/kg/day1.5 g/kg/day−3.1 SDS−1.3 SDSLast hospitalization (for salt wasting and bronchopneumonia) at 11 months.

Adachi et al. [18]20SCNN1G 1627delG,
SCNN1G 1570-1G>A
Compound heterozygous
00−2.2 SDSNADiscontinued salt supplementation at age of 11 years; one further hospitalization and IV outpatient therapy ×3 since that time.

Schweiger et al. [19]1SCNN1A Nt505delAC
Frameshift, homozygous
11 mEq/kg/day NaCl
12 mEq/kg/day Na Citrate
NA5th percentile1st percentileMild oxygen requirement with chronic cough.

Belot et al. [20]
Patient 13SCNN1B c.637C>T/p Gln213stop, homozygous50 mEq/kg/dayNA50th percentile50th percentileFed by gastrostomy; frequent severe dehydration attacks.
Patient 25SCNN1A c.1621C>T/p Arg508stop, homozygous30 mEq/kg/dayNA50th percentile50th percentileRepeated severe dehydration episodes and bronchitis attacks.
Patient 30.67SCNN1G c.1318C>T/p Arg440stop, homozygous27 mEq/kg/dayNA50th percentile20th percentileSevere hyperkalemia at 5 months after gastroenteritis.

Thomas et al. [21]7SCNN1B
Deletion in promoter region, homozygous
NANANANASignificant respiratory symptoms with frequent hospitalizations when young; by age 7 years only symptom was exercise-induced cough.

Saxena et al. [22]
Patient 1115SCNN1A 1621C>T
Homozygous
NANANANAStill requiring high amounts of sodium supplementation.
Patient 146.5SCNN1A 1669 +1 G>A
Splice-site, homozygous
16 g/day [14]NA10–25th percentile10–25th percentileRepeated salt wasting episodes with decreasing frequency with age; died of cardiac arrest at age 6.5 years.
Patient 164SCNN1A 1439insT150–180 mEq/day15 g/dayNANAStable.

Welzel et al. [23]
Patient 117SCNN1A c.587_588insC
Frameshift, premature stop, homozygous
11.5 mEq/kg/dayNANormal heightObeseRecurrent salt wasting crises; cystic fibrosis-like phenotype with bronchiectasis.
Patient 211.5SCNN1A c.1342_1343insTACA
Frameshift, premature stop, homozygous
NANANormal heightNormal weightSalt wasting crises occurring once a year; no pulmonary symptoms.
Patient 31.75SCNN1A c.742delG
Premature stop, homozygous
19 mEq/kg/day0.4 g/kg/day−1.87 SDS−2.15 SDSRecurrent mild prolonged respiratory tract infections; eczema-like skin lesions.
Patient 43.8SCNN1A c.587_588insC
Frameshift, premature stop, homozygous
20–28 mEq/kg/dayNA−2.17 SDSNAGastrostomy tube placed for failure to thrive; 2 pulmonary infections.
Patient 51.7SCNN1A c.1474C>T
Missense, premature stop, homozygous
34 mEq/kg/dayNA−0.7 SDS−1.2 SDSRecurrent salt wasting crises; cardiac arrest at age of 11 months during a crisis; pulmonary infections; mild rashes.
Patient 60.9SCNN1A c.189C>A
Premature stop, homozygous
17 mEq/kg/dayNANANANeuromotor developmental delay; recurrent pulmonary infections; atopic-dermatitis-like rash; died of electrolyte imbalance during sepsis at age 11 months.
Patient 70.7SCNN1A c.1361-2A>G
Splice-site, homozygous
10 mEq/kg/dayNANANAHospitalized for hyponatremic convulsion; 4 episodes of severe bronchiolitis.

NA: not available.