A Case of Pseudo-Bartter Syndrome Associated with Dysorexia Nervosa

Abstract

We encountered a 37-year-old woman with dysorexia nervosa (bulimia, vomiting, amenorrhea and obese-aversion) satisfied the criteria for Pseudo-Bartter syndrome, including hypokalemia, hyper-plasma renin activity, normal blood pressure, and poor response against exogenous angiotensin II/angiotensin II analogue as a result of self-administration of Colac^[○!R] (Bisacodyl) 50mg/day for more than 5 years. It was considered that the cause of hypokalemia was due to the excessive potassium excretino into the feces, 26.0mEq/day (potassium in diet, 70mEq/day). On the other hand, the urine potassium secretion was very low. Hormonal examination and thyroid aspiration biopsy revealed euthyroid chronic thyroiditis histologically, low T_3 syndrome and abnormal hGH response after TRH bolus injectin. The correlation between chronic thyroiditis and Pseudo-Bartter syndrome was unknown. Various drugs were administered to normalize serum potassium concentration. Exogenous potassium, Captopril, Indomethacin, Spironolactone were not effective. But only 2mg/day of Loperamide, antagonist prostaglandin-induced diarrhea, was effective. As long as the authors are aware, this is the first report that Loperamide is useful in hypokalemia of Pseudo-Bartter syndrome.Psychosomatic approach to the patient led to the insight for the mechanism of the disease. Eating attitude test (EAT) score was also improved.