Gitelman's syndrome and pregnancy: new potential pathophysiological influencing factors, therapeutic approach and materno-fetal outcome.

In the last twenty years the knowledge of biochemical, hormonal and molecular abnormalities of Gitelman's syndrome, the most common phenotype of inherited hypokalemic salt losing renal tubular disorders, is increased in the medical community. In parallel with the increasing number of adult population affected by the syndrome and the remarkable improvement of its management, pregnancy have become an important issue for patients affected and their physicians. There are, however, few reports of pregnancies in Gitelman's patients. We review here the cases of pregnancies in Gitelman's patients reported in literature and report three more cases from our cohort of Gitelman's patients, giving particular attention to the materno-fetal outcome and therapeutic approach. The possible influences on pregnancy of Gitelman's patient of other main hemodynamic, hormonal and molecular features of Gitelman's syndrome such as cardiovascular hyporesponsiveness, abnormal vascular tone regulation, upregulation of nitric oxide and Angiotensin 1-7 systems with their possible influence on the reported alteration of cardiac rhythm and function, are also considered.