Skip to main content
Log in

A novel homozygous SLC12A3 mutation causing Gitelman syndrome with co-existent autoimmune thyroiditis: a case report and review of the literature

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

Gitelman syndrome is a rare, autosomal recessively inherited tubulopathy manifesting with hypokalemia, hypomagnesemia, hypocalciuria, and metabolic alkalosis. Common symptoms include fatigue, myalgia, reduced performance capacity, tetany, paresthesia, and delayed growth. However, as reported in the literature, diagnosis in some patients is prompted by an incidental finding of hypokalemia. GS develops due to mutations in the SLC12A3 gene, which encodes the thiazide-sensitive Na-Cl cotransporter. Many variants in the SLC12A3 gene causing GS have been reported in literature. A new pathogenic homozygous mutation (c.2612G > T), absence of hypomagnesemia, and accompanying autoimmune thyroiditis are remarkable in our patient. There are a few Gitelman syndrome cases that are complicated with autoimmune thyroiditis in the literature. In this study, we present a case of Gitelman syndrome with a novel homozygous mutation and accompanying autoimmune thyroiditis and review of the literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

GS:

Gitelman syndrome

BS:

Bartter syndrome

NCC:

Na-Cl cotransporter

CKD:

Chronic kidney disease

References

  1. Gitelman H, Graham J, Welt L. A new familial disorder characterized by hypokalemia and hypomagnesemia. Trans Assoc Am Physicians. 1966;79:221–35.

    CAS  PubMed  Google Scholar 

  2. Hsu Y-J, Yang S-S, Chu N-F, Sytwu H-K, Cheng C-J, Lin S-H. Heterozygous mutations of the sodium chloride cotransporter in Chinese children: prevalence and association with blood pressure. Nephrol Dial Transplant. 2009;24:1170–5.

    Article  CAS  PubMed  Google Scholar 

  3. Aoi N, Nakayama T, Tahira Y, Haketa A, Yabuki M, Sekiyama T, et al. Two novel genotypes of the thiazide-sensitive Na-Cl cotransporter (SLC12A3) gene in patients with Gitelman’s syndrome. Endocrine. 2007;31:149–53.

    Article  CAS  PubMed  Google Scholar 

  4. Dong H, Lang Y, Shao Z, Li L, Shao L. Coexistence of Gitelman’s syndrome and thyroid disease: SLCl2A3 gene analysis in two patients. Chin J Endocrinol Metab. 2010;26:395–8.

    CAS  Google Scholar 

  5. Xu X, Sun M, Liu X, Chen H, Xu K, Tang W. Clinical feature and genetic analysis of Gitelman’s syndrome accompanied by autoimmune thyroid disease. Chin J Endocrinol Metab. 2013;29:50–4.

    CAS  Google Scholar 

  6. Zha B, Zheng P, Liu J, Huang X. Coexistence of Graves’ Disease in a 14-year-old young girl with Gitelman Syndrome. Clin Endocrinol (Oxf). 2015;83:995–7.

    Article  PubMed  Google Scholar 

  7. Baldane S, Ipekci SH, Celik S, Gundogdu A, Kebapcilar L. Hypokalemic paralysis due to thyrotoxicosis accompanied by Gitelman’s syndrome. Indian J Nephrol. 2015;25:103–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Mizokami T, Hishinuma A, Kogai T, Hamada K, Maruta T, Higashi K, et al. Graves’ disease and Gitelman syndrome. Clin Endocrinol (Oxf). 2016;84:149–50.

    Article  PubMed  Google Scholar 

  9. Zhou H, Liang X, Qing Y, Meng B, Zhou J, Huang S, et al. Complicated Gitelman syndrome and autoimmune thyroid disease: a case report with a new homozygous mutation in the SLC12A3 gene and literature review. BMC Endocr Disord. 2018;18:82.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Liu S, Ke J, Zhang B, Yu C, Feng Y, Zhao D. A novel compound heterozygous variant of SLC12A3 gene in a pedigree with Gitelman syndrome co-existent with thyroid dysfunction. Endocr Pract. 2018;24:889–93.

    Article  PubMed  Google Scholar 

  11. Oba T, Kobayashi S, Nakamura Y, Nagao M, Nozu K, Fukuda I, et al. A case of Gitelman syndrome that was difficult to distinguish from hypokalemic periodic paralysis caused by graves’ disease. J Nippon Med Sch. 2019. https://doi.org/10.1272/jnms.JNMS.2019_86-505.

    Article  PubMed  Google Scholar 

  12. Que C, Zhang J, Chen Y, Hou N. A case of Gitelman syndrome with Hashimoto’s thyroiditis. Shanghai Med J. 2020;43:762–4.

    Google Scholar 

  13. Peng B, Wang H, Yang Y, Xu W, Yuan G. A case of Gitelman syndrome with Graves disease as initial diagnosis. Chin J Intern Med. 2020;59:382–4.

    CAS  Google Scholar 

  14. Wang L, Mou L, Zhao H, Zhu H. A case of Gitelman syndrome with hyperthyroidism. Chin J Emerg Med. 2020;29:1375–7.

    Google Scholar 

  15. Song M, Wang N, Li Z, Yin P. Clinical feature and gene mutation analysis of 2 cases of hyperthyroidism complicated with Gitelman syndrome. Jiangsu Med J. 2021;47:424–8.

    Google Scholar 

  16. Yu S, Wang C. Genetic analysis of Gitelman syndrome: co-existence with hyperthyroidism in a two-year-old boy. Endocr Metab Immune Disord Drug Targets. 2021;21:1524–30.

    Article  CAS  PubMed  Google Scholar 

  17. Zhang J-H, Ruan D-D, Hu Y-N, Ruan X-L, Zhu Y-B, Yang X et al. Review and analysis of two Gitelman syndrome pedigrees complicated with proteinuria or Hashimoto’s thyroiditis caused by compound heterozygous SLC12A3 mutations. 2021. https://doi.org/10.1155/2021/9973161

  18. Qin Y-Z, Liu Y-M, Wang Y, You C, Li L-N, Zhou X-Y, et al. Novel compound heterozygous mutation of SLC12A3 in Gitelman syndrome co-existent with hyperthyroidism: a case report and literature review. World J Clin Cases. 2022;10:7483–94.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Xu J, He J, Xu S, Wang R, Peng N, Zhang M. Gitelman syndrome with Graves’ disease leading to rhabdomyolysis: a case report and literature review. BMC Nephrol. 2023;24:123.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Richards S, Aziz N, Bale S, Bick D, Das S, Gastier-Foster J, et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015;17:405–24.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Downie ML, Lopez Garcia SC, Kleta R, Bockenhauer D. Inherited tubulopathies of the kidney: insights from genetics. Clin J Am Soc Nephrol. 2021;16:620–30.

    Article  CAS  PubMed  Google Scholar 

  22. Knoers NV, Levtchenko EN. Gitelman syndrome. Orphanet J Rare Dis. 2008;3:22. https://doi.org/10.1186/1750-1172-3-22.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Riveira-Munoz E, Chang Q, Bindels RJ, Devuyst O. Gitelman’s syndrome: towards genotype-phenotype correlations? Pediatr Nephrol. 2007;22:326–32.

    Article  PubMed  Google Scholar 

  24. Shen Q, Chen J, Yu M, Lin Z, Nan X, Dong B, et al. Multi-centre study of the clinical features and gene variant spectrum of Gitelman syndrome in Chinese children. Clin Genet. 2021;99:558–64.

    Article  CAS  PubMed  Google Scholar 

  25. Zhong F, Ying H, Jia W, Zhou X, Zhang H, Guan Q, et al. Characteristics and follow-up of 13 pedigrees with Gitelman syndrome. J Endocrinol Invest. 2019;42:653–65.

    Article  CAS  PubMed  Google Scholar 

  26. Fujimura J, Nozu K, Yamamura T, Minamikawa S, Nakanishi K, Horinouchi T, et al. Clinical and genetic characteristics in patients with Gitelman syndrome. Kidney Int Rep. 2019;4:119–25.

    Article  PubMed  Google Scholar 

  27. Glaudemans B, Yntema HG, San-Cristobal P, Schoots J, Pfundt R, Kamsteeg E-J, et al. Novel NCC mutants and functional analysis in a new cohort of patients with Gitelman syndrome. Eur J Hum Genet. 2012;20:263–70.

    Article  CAS  PubMed  Google Scholar 

  28. Lin S-H, Shiang J-C, Huang C-C, Yang S-S, Hsu Y-J, Cheng C-J. Phenotype and genotype analysis in Chinese patients with Gitelman’s syndrome. J Clin Endocrinol Metab. 2005;90:2500–7.

    Article  CAS  PubMed  Google Scholar 

  29. Lo Y-F, Nozu K, Iijima K, Morishita T, Huang C-C, Yang S-S, et al. Recurrent deep intronic mutations in the SLC12A3 gene responsible for Gitelman’s syndrome. Clin J Am Soc Nephrol. 2011;6:630–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Tseng M-H, Yang S-S, Hsu Y-J, Fang Y-W, Wu C-J, Tsai J-D, et al. Genotype, phenotype, and follow-up in Taiwanese patients with salt-losing tubulopathy associated with SLC12A3 mutation. J Clin Endocrinol Metab. 2012;97:E1478–82.

    Article  CAS  PubMed  Google Scholar 

  31. Zeber-Lubecka N, Suchta K, Kulecka M, Kluska A, Piątkowska M, Dabrowski MJ, et al. Exome sequencing to explore the possibility of predicting genetic susceptibility to the joint occurrence of polycystic ovary syndrome and Hashimoto’s thyroiditis. Front Immunol. 2023;14:1193293.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Gong L, Liu B, Wang J, Pan H, Qi A, Zhang S, et al. Novel missense mutation in PTPN22 in a Chinese pedigree with Hashimoto’s thyroiditis. BMC Endocr Disord. 2018;18:76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Lo MS, Towne M, VanNoy GE, Brownstein CA, Lane AA, Chatila TA, et al. Monogenic Hashimoto thyroiditis associated with a variant in the thyroglobulin (TG) gene. J Autoimmun. 2018;86:116–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Oguzhan Koca.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Written informed consent was obtained from the patient for the publication of her clinical data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koca, O., Alay, M.T., Murt, A. et al. A novel homozygous SLC12A3 mutation causing Gitelman syndrome with co-existent autoimmune thyroiditis: a case report and review of the literature. CEN Case Rep (2024). https://doi.org/10.1007/s13730-023-00845-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13730-023-00845-z

Keywords

Navigation