Acquired autoimmune Bartter syndrome in a patient with primary hypothyroidism

Noreen Nasir, Deepali Mohanty, Arun Kumar Pande, Dhanita Khanna, Kavita Vishvakarma, Latika Gupta

Research output: Contribution to journalArticlepeer-review

Abstract

We describe an unusual clinical presentation of autoimmune Bartter syndrome in a patient with primary hypothyroidism. A 65-year-old female patient was admitted with neuromuscular weakness associated with hypokalemia and metabolic alkalosis. She had a suboptimal response to potassium supplementation and potassium-sparing diuretic resulting in re-hospitalization with the same symptoms. A detailed serum and urinary biochemistry analysis in the absence of other causes of potassium wasting helped diagnose Bartter syndrome, a rare entity in adults. An autoimmune profile showed anti-Scl-70 antibody to be positive, although she did not develop other systemic features of the disease. Our patient responded to a steroid-based regimen potassium supplement, Indomethacin, and aldosterone antagonist with remarkable resolution of symptoms and correction of electrolyte derangement. We reviewed the literature to search for similar cases and included twenty-seven full-length publications on acquired and autoimmune causes of Bartter syndrome. Our case highlights the fact that hypokalemia with metabolic alkalosis in an adult patient should prompt clinicians to evaluate for common and uncommon conditions. While assessing for abnormal conditions, acquired Bartter syndrome should be considered if a patient has an underlying autoimmune, endocrine, or connective tissue disease.

Original languageEnglish
Pages (from-to)567-574
Number of pages8
JournalRheumatology International
Volume43
Issue number3
Early online date20 Nov 2021
DOIs
Publication statusPublished - 1 Mar 2023

Keywords

  • Adult
  • Female
  • Humans
  • Aged
  • Bartter Syndrome/complications
  • Hypokalemia/complications
  • Potassium
  • Alkalosis/complications
  • Hypothyroidism
  • Metabolic alkalosis
  • Bartter's syndrome
  • Hypokalemia
  • Autoimmune

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