Multiple neoplasia in a patient with Gitelman syndrome harboring germline monoallelic MUTYH mutation

A case of advanced breast cancer with Gitelman syndrome

Gitelman syndrome (GS) is a rare, mostly autosomal recessive disease this is a salt-losing tubulopathy caused by mutation of genes encoding sodium chloride (NCCT) and magnesium transporters in the thiazide-sensitive segments of the distal nephron. We encountered a 45-year-old female who has suffered from whole-body weakness because of hypokalemia for 8 years and diagnosed with Gitelman syndrome clinically. She visited the hospital with a complaint of an unrelieved hard mass of the left breast. The tumor was diagnosed as human epidermal growth factor receptor 2 (HER2)-positive breast cancer. We herein report this first case of a breast cancer patient with Gitelman syndrome who developed other neoplasms including colon polyp, adrenal adenoma, an ovarian cyst, and multiple uterine fibroids and provide a review of the pertinent literature.

Gitelman syndrome: A first published clinical association with chronic pancreatitis, a case report and review of literature

Introduction and importance

Gitelman syndrome (GS) is an autosomal recessive, salt-losing tubulopathy, also referred to as familial hypokalemia-hypomagnesemia, caused by mutation of genes encoding the sodium chloride cotransporter (NCCT) and magnesium transporters in the thiazide sensitive segments of the distal convoluted tubule (DCT) of the nephron. Patients may present with a spectrum of clinical presentations and associations.

Case presentation

Here, we report a case of a 39-year-old female with Gitelman syndrome and chronic pancreatitis in the absence of well-known causes of CP. Her clinical and radiographic profile constituted an indication for surgical intervention, namely pancreatic head and body coring and pancreaticojejunostomy (Frey's procedure) (FP). On follow up 3 month later, the patient is pain-free and is satisfied. To the best of our knowledge and based on literature review, this is the first reported case of GS with CP.

Conclusion

The purpose of this paper is to describe a case of CP in association with established GS as a first published clinical association, raising a possibility of another possible clinical manifestation of GS. Further observational studies are encouraged to support this association.

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Gitelman Syndrome is a rare disease with many different associations. Before this case report, it was never reported to be associated with chronic pancreatitis.

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Our reported patient has been having multiple attacks of acute on top of chronic pancreatitis, despite the negative history of predisposing factors of chronic pancreatitis

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The purpose of this report is to discuss the clinical and radiological findings of such disease, the proposed surgical treatment and the approach in light of our experience.

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We hope after publishing this case report to help and to put such association under the microscope in the hope of improving the patients’ outcome.

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Further studies are needed to support or challenge this association and to better understand the pathophysiology of chronic pancreatitis in patients with Gitelman syndrome.