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Acquired autoimmune Bartter syndrome in a patient with primary hypothyroidism

Rheumatology International (2021)Cite this article

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.

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Acknowledgements

I would like to acknowledge the multi-disciplinary care team at Sahara Hospital, Lucknow for the academic and clinical support.

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Authors and Affiliations

  1. Section of Internal Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan

    Noreen Nasir

  2. Department of Medicine, Sahara Hospital, Lucknow, India

    Deepali Mohanty

  3. Department of Endocrinology, Sahara Hospital, Lucknow, India

    Arun Kumar Pande

  4. Department of Rheumatology, Sahara Hospital, Lucknow, India

    Dhanita Khanna

  5. Department of Nephrology, Ajanta Hospital, Lucknow, India

    Kavita Vishvakarma

  6. Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Latika Gupta

  7. Lucknow Endocrine and Diabetes Clinic, Lucknow, India

    Arun Kumar Pande

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  1. Noreen Nasir
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  2. Deepali Mohanty
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Contributions

Conception and design of the work: AKP. Acquisition, analysis, and interpretation of data: all authors. Drafting of the manuscript: NN. Revising it critically for important intellectual content: all authors. Final approval of the version to be published: all authors. Agreement to be accountable for all aspects of the work regarding accuracy and integrity: all authors. Moreover, all authors read and approved the final manuscript.

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Correspondence to Arun Kumar Pande.

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Written informed consent was obtained from the patient's daughter for the publication of this case report. A copy of the written permission is available for review by the Editor-in-Chief of this Journal.

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Nasir, N., Mohanty, D., Pande, A.K. et al. Acquired autoimmune Bartter syndrome in a patient with primary hypothyroidism. Rheumatol Int (2021). https://doi.org/10.1007/s00296-021-05042-8

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Keywords

  • Hypokalemia
  • Metabolic alkalosis
  • Bartter's syndrome
  • Autoimmune