Abstract
We present a case of a female infant diagnosed with secondary pseudohypoaldosteronism (PHA) who exhibited weight loss, hyponatremia, hyperkalemia, and metabolic acidosis without the presence of urinary tract anomalies (UTA) or urinary tract infections (UTI). She was born at 35 weeks gestation and developed electrolyte abnormalities. Initially managed for transient tachypnea of the newborn, she developed respiratory distress requiring mechanical ventilation. Subsequently, she exhibited persistent hyponatremia, hyperkalemia, and metabolic acidosis despite adequate fluid therapy, prompting consideration of adrenal insufficiency and congenital adrenal hyperplasia (CAH). Treatment with hydrocortisone and fludrocortisone was initiated empirically until hormonal analyses excluded CAH. Further evaluation excluded UTA and UTI as underlying causes, implicating secondary PHA. The infant responded well to saline and electrolyte replacement therapy, with normalization of electrolyte levels and clinical improvement. Follow-up assessments demonstrated resolution of electrolyte imbalances, and the patient was discharged after 27 days, at an adjusted age of 38 weeks and 6 days, without further complications. Secondary PHA, characterized by renal tubular resistance to aldosterone, typically presents with severe electrolyte disturbances in infancy. It can occur independently of UTA or UTI, highlighting the importance of considering this diagnosis in neonates and infants presenting with hyponatremia, hyperkalemia, and metabolic acidosis that do not respond to conventional therapies. Early recognition and appropriate management, including fluid-electrolyte correction, and hormone replacement if indicated, are crucial to prevent life-threatening complications associated with salt-wasting syndromes in this vulnerable population.
Keywords: Secondary pseudohypoaldosteronism, newborn, no urinary tract anomaly or infection
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