Calcium Unresponsive Hypocalcemic Tetany: Gitelman Syndrome with Hypocalcemia

Abstract

Introduction. Gitelman's syndrome (GS) is autosomal recessive renal tubular disorder characterized by hypokalemia, hypomagnesemia, hypocalciuria, metabolic alkalosis, and hyperreninemic hyperaldosteronism. It is usually associated with normal serum calcium. We report a patient presented with hypocalcemic tetany, and evaluation showed Gitelman's syndrome with hypocalcemia. Case Report. A 28-year-old woman presented with cramps of the arms, legs, fatigue, and carpal spasms of one week duration. She has history of similar episodes on and off for the past two years. Her blood pressure was 98/66 mmHg. Chvostek's sign and Trousseau's sign were positive. Evaluation showed hypokalemia, hypocalcemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. Self-medication, diuretic use, laxative abuse, persistent vomiting, and diarrhoea were ruled out. Urinary prostaglandins and genetic testing could not be done because of nonavailability. To differentiate Gitelman syndrome from Bartter's syndrome (BS), thiazide loading test was done. It showed blunted fractional chloride excretion. GS was confirmed and patient was treated with spironolactone along with magnesium, calcium, and potassium supplementation. Symptomatically, she improved and did not develop episodes of tetany again. Conclusion. In tetany patient along with serum calcium measurement, serum magnesium, serum potassium, and arterial blood gases should be measured. Even though hypocalcemia in Gitelman syndrome is rare, it still can occur.

Gitelman syndrome presenting with cerebellar ataxia and tetany

“…GS is a salt-losing tubulopathy characterized by hypokalemia, metabolic alkalosis with hypomagnesemia, hypocalciuria, and hyperreninemia. There are several case reports wherein GS was diagnosed in patients presenting with persistent hypokalemia,[ 3 , 4 ] sudden quadriparesis,[ 5 ] unresponsive tetany,[ 6 ] and severe hypocalcemia with periodic paralysis. [ 7 ] Our patient also presented with involuntary movements, ataxia, carpopedal spasm, and was then detected to have metabolic alkalosis with hypokalemia, hypocalcemia, and hypomagnesemia.…”

Hyperemesis Gravidarum With Paraparesis and Tetany

“…Although not typically occurring, hypocalcemic tetany in Gitelman's syndrome has been reported in the literature as a very rare association. There have been reported cases of periodic paralysis and hypocalcemic tetany occurring in association with Gitelman's syndrome [3][4][5], where hypocalcemia has been attributed to chronic hypomagnesemia resulting in altered metabolism of PTH. Although our patient had hypomagnesemia, hypokalemia, and hypocalcemia, metabolic alkalosis or wasting of salts in urine was not present.…”

Hypocalcaemia and hyponatraemia masquerading the diagnosis of Gitelman syndrome

“…This rare manifestation is most probably due to the presence of hypomagnesaemia. Magnesium is required for the synthesis and release of PTH hence deficiency results in inadequate PTH levels and resultant secondary hypocalcaemia 24 25. Pantanetti et al ,26 and Nakamura et al 27 described two patients with Gitelman syndrome in whom hypocalcaemia developed due to hypomagnesaemia.…”