An Uncommon Presentation of Bartter Syndrome in an Adult: A Case Report

Bartter syndrome is an uncommon autosomal recessive renal tubular condition that is usually diagnosed in childhood; there are few reports of adult-onset cases and even fewer that are correctly diagnosed. We present a 48-year-old woman with no co-morbidities who was seen with generalized weakness, fatigue, carpopedal spasms and tingling in both hands, muscle cramps, and frequent urination. Clinical assessment showed a positive Trousseaus sign, and laboratory tests established hypokalemia, metabolic alkalosis, hyper reninism, hypocalcemia and hypercalciuria with renal biopsy showing juxtaglomerular hyperplasia. The patient was treated with intravenous potassium and calcium supplementation, ACE inhibitors, NSAIDS, followed by oral therapy, dietary counseling. She stayed asymptomatic on follow-up. Adult-onset Bartter syndrome is a rare clinical phenomenon that must be kept in mind in the differential diagnosis of unexplained metabolic alkalosis and hypokalemia, particularly in normotensive individuals. Timely diagnosis and proper treatment may result in outstanding outcomes. This case highlights the significance of recognizing late-onset variants and distinguishing them from other tubulopathies like Gitelman syndrome.