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Case Reports in Endocrinology
Volume 2016, Article ID 6384697, 3 pages
http://dx.doi.org/10.1155/2016/6384697
Case Report

Pseudohypoaldosteronism in a Neonate Presenting as Life-Threatening Hyperkalemia

1Department of Pediatric Endocrinology and Metabolism, King Abdulaziz Medical City, Jeddah 21423, Saudi Arabia
2King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia

Received 10 November 2015; Accepted 30 December 2015

Academic Editor: Lucy Mastrandrea

Copyright © 2016 Najya A. Attia and Yousef I. Marzouk. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Context. Pseudohypoaldosteronism type 1 (PHA1) is a life-threatening disease that causes severe hyperkalemia and cardiac arrest if not treated appropriately or if diagnosis is missed. Objective. To report a case of a newborn with vomiting and lethargy, ultimately diagnosed with pseudohypoaldosteronism. Patient. This case presented to the ED at an age of 14 days in hypovolemic shock. There was a family history of sudden infant death, her sister who was diagnosed with CAH and passed away at 3 months of age despite regular hormone replacement. Our patient had cardiac arrest in ED, due to hyperkalemia; while receiving fluid boluses, cardiopulmonary resuscitation was initiated. After stabilization, diagnostic workup demonstrated persistently low sodium, acidosis, and high potassium, which required peritoneal dialysis. Based on these findings, the patient was diagnosed with CAH. It turned out later that the patient had PHA1. Two years later, the patient had a new sibling with the same disease diagnosed at birth and started immediately on treatment without any complication. Conclusions and Outcome. This case highlights the significant diagnostic and therapeutic challenges in treating children with PHA1. Adrenal crisis is not always CAH; delayed diagnosis can lead to complication and even death. The presence of high plasma renin activity, aldosterone, and cortisol, along with the presence of hyponatremia and hyperkalemia, established the diagnosis of PHA type 1 and ruled out CAH.