July - September 2013, Volume 9, Issue 3

Korkmaz H, Özkaya M., Akarsu E., Öztürk Z.A., Koç I., Araz M

Bartter Syndrome Mimicking Hypopituitarism

Acta Endo (Buc) 2013, 9 (3): 479-486
doi: 10.4183/aeb.2013.479

Introduction. Bartter’s Syndrome is a renal tubular defect characterized with low or normal blood pressure, hypokalemic metabolic alkalosis and hyperreninemic hyperaldosteronism due to renal sodium loss. Herein we reported a case who presented with growth retardation, growth hormone deficiency previously treated with growth hormone for a period of 6 months in mind and with hypopituitarism similar findings such as primary amenorrhea, fatigue, weakness and just diagnosed as Bartter’s syndrome. Case report. A 18 year-old female patient was referred to our hospital for amenorrhea, growth retardation and fatigue. Her history revealed that she was diagnosed with growth hormone deficiency two years ago and given growth hormone treatment for 6 months. Physical examination showed growth retardation. Laboratory tests revealed that serum potassium was 2,3 mmol/L. Further investigations demonstrated metabolic alkalosis, increased urinary potassium excretion and hyperreninemic hyperaldosteronism. The patient was considered as Bartter syndrome and spironolactone, indomethacin and potassium chloride were initiated. While she had growth retardation and primary amenorrhea, we searched basal hormone levels and performed stimulation tests for evaluating pituitary reserve. Insulin tolerance test showed that serum growth hormone and cortisol levels were 10 mcg/dL and 19 mcg/dL respectively during hypoglycemic period. It demonstrated that both of the axes were intact. Luteinizing hormone releasing hormone test showed that hypothalamo pituitary gonadal axis was also intact. Conclusions. Bartter syndrome can lead to growth retardation that mimicking hypopituitarism in case of delay in diagnosis.

Keywords: Bartter syndrome, hypopituitarism, growth retardation.

Correspondence: Hakan Korkmaz MD, Gaziantep University, Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, 27100 Sahinbey, Gaziantep, Turkey, E-mail: drhkorkmaz@yahoo.com.tr