title: Gitelman syndrome as a cause of psychomotor retardation in a toddler.
abstract: BACKGROUND
  Gitelman syndrome (GS) is a very rare autosomal recessive tubulopathy due to loss-of-function or mutation in solute carrier family12, member 3 gene (SLC12A3 gene) encoding thiazide-sensitive NaCl co-transporter in the distal convoluted tubule, leading to hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria and low-to-normal blood pressure. Clinical signs are mostly secondary to chronic hypokalemia and include dizziness, fatigue, constipation and weakness. Patients can also present with muscle cramps, tetany, fatigue and convulsions due to severe metabolic alkalosis or hypomagnesemia. Manifestations of GS are rarely apparent before the age of five, and the syndrome is usually diagnosed during adolescence or adulthood. Here we describe a case of GS presenting in infancy with hypokalemia and psychomotor retardation.
  
  
  METHODS
  We present an 18-month-old boy who presented with psychomotor retardation and failure to thrive. Investigations revealed hypokalemia at 2.7 mmol/L, metabolic alkalosis, hypocalciuria and normal serum magnesium level. The diagnoses of Barter syndrome (BS) and Gitelman syndrome (GS) were considered. Genetic studies confirmed the diagnosis of GS and three different mutations of in SLC12A3 gene were detected. Two mutations (c.2576T>C and c.2929C>Ty) were considered as causal ones, with the patient´s parents being the heterozygous carriers. Oral potassium supplementation resulted in normalisation of the hypokalemia and psychomotor improvement.
  
  
  CONCLUSIONS
  We report a rare case of psychomotor retardation occurring at an early age in genetically confirmed GS. In spite of being a rare disorder, GS has to be considered in children with developmental delay and muscle weakness. With adequate treatment, GS patients have an excellent prognosis.
authors.affiliation: Department of Pediatrics, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic. skalovasylva@seznam.cz
authors.forename: Sylva
authors.initials: S
authors.lastname: Skalova
authors.forename: David
authors.initials: D
authors.lastname: Neuman
authors.forename: Petr
authors.initials: P
authors.lastname: Lnenicka
authors.forename: Jitka
authors.initials: J
authors.lastname: Stekrova
mesh_terms: D019587:Dietary Supplements; D004232:Diuretics / Q000627:therapeutic use; D005183:Failure to Thrive / Q000209:etiology; D053579:Gitelman Syndrome / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D006801:Humans; D007223:Infant; D008297:Male; D011189:Potassium Chloride / Q000627:therapeutic use; D011596:Psychomotor Disorders / Q000188:drug therapy / Q000209:etiology*; D011955:Receptors, Drug / Q000235:genetics; D064486:Solute Carrier Family 12, Member 3; D013148:Spironolactone / Q000627:therapeutic use; D027981:Symporters / Q000235:genetics
chemical_list: D004232:Diuretics; D011955:Receptors, Drug; C578874:SLC12A3 protein, human; D064486:Solute Carrier Family 12, Member 3; D027981:Symporters; D013148:Spironolactone; D011189:Potassium Chloride