See Ting-Ting, Lee Siu-Pak
Section of Endocrinology and Metabolism, Department of Internal Medicine, Far Eastern Memorial Hospital, Panchiao, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2009 Feb;72(2):88-90. doi: 10.1016/S1726-4901(09)70029-2.
We report a rare case of Bartter's syndrome in a 35-year-old woman with type 2 diabetes mellitus. The patient presented with leg weakness, fatigue, polyuria and polydipsia. Hypokalemia, metabolic alkalosis, and high renin and aldosterone concentrations were present, but the patient was normotensive. Gitelman's syndrome was excluded because of the presence of hypercalciuria, secondary hyperparathyroidism and bilateral nephrocalcinosis. The patients condition improved upon administration of a prostaglandin synthetase inhibitor (acemetacin), oral potassium chloride and potassium-sparing diuretics. Five months later, the patient discontinued acemetacin because of epigastric discomfort; at the same time, severe hypokalemia and hyperglycemia developed. Glucagon stimulation and water deprivation tests were performed. Type 2 diabetes mellitus with nephrogenic diabetes insipidus was diagnosed. To avoid further gastrointestinal complications, the patient was treated with celecoxib, a selective cyclooxygenase 2 inhibitor. This case serves as a reminder that Bartter's syndrome is associated with various metabolic derangements including nephrogenic diabetes insipidus, nephrocalcinosis and diabetes mellitus. When treating Bartter's syndrome, it is also prudent to remember that the long-term use of nonsteroidal anti-inflammatory drugs and potassium-sparing diuretics may result in serious adverse reactions.
我们报告了一例罕见的巴特综合征病例，患者为一名35岁的2型糖尿病女性。患者出现腿部无力、疲劳、多尿和烦渴症状。存在低钾血症、代谢性碱中毒以及肾素和醛固酮浓度升高，但患者血压正常。由于存在高钙尿症、继发性甲状旁腺功能亢进和双侧肾钙质沉着症，排除了吉特林综合征。给予前列腺素合成酶抑制剂（阿西美辛）、口服氯化钾和保钾利尿剂后，患者病情改善。五个月后，患者因上腹部不适停用阿西美辛；与此同时，出现了严重的低钾血症和高血糖。进行了胰高血糖素刺激试验和禁水试验。诊断为2型糖尿病合并肾性尿崩症。为避免进一步的胃肠道并发症，患者接受了选择性环氧化酶2抑制剂塞来昔布治疗。该病例提醒我们，巴特综合征与包括肾性尿崩症、肾钙质沉着症和糖尿病在内的各种代谢紊乱有关。在治疗巴特综合征时，还应谨慎记住，长期使用非甾体抗炎药和保钾利尿剂可能会导致严重的不良反应。
