Bartter's syndrome with type 2 diabetes mellitus

Area of Science:

• Nephrology
• Endocrinology
• Internal Medicine

Background:

• Bartter's syndrome is a rare genetic disorder affecting ion transport in the kidney.
• It leads to electrolyte imbalances, including hypokalemia and metabolic alkalosis.
• Co-occurrence with other endocrine and metabolic disorders is uncommon but significant.

Observation:

• A 35-year-old woman with type 2 diabetes presented with symptoms of Bartter's syndrome.
• Initial treatment with a prostaglandin synthetase inhibitor improved her condition.
• Discontinuation of the inhibitor led to severe hypokalemia and hyperglycemia, revealing nephrogenic diabetes insipidus.

Findings:

• The patient exhibited hypercalciuria, secondary hyperparathyroidism, and bilateral nephrocalcinosis, differentiating from Gitelman's syndrome.
• Type 2 diabetes mellitus and nephrogenic diabetes insipidus were diagnosed concurrently.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and potassium-sparing diuretics were used for management, necessitating careful monitoring for adverse effects.

Implications:

• Bartter's syndrome can present with complex metabolic derangements, including diabetes mellitus and nephrogenic diabetes insipidus.
• Long-term NSAID and diuretic use in Bartter's syndrome patients carries risks of serious adverse reactions.
• This case underscores the importance of comprehensive evaluation and individualized treatment strategies for rare kidney disorders.