Growth characteristics and factors influencing growth in Bartter's syndrome

Abstract

Studies on growth patterns of patients with Bartter's syndrome indicate that these patients are not dwarfs, as previously considered. They manifest severe growth retardation during infancy and early childhood, but have a delayed adolescent growth spurt sometime after the seventeenth year. Normal height is eventually attained. Correcting the potassium-deficient state and improving the hypokalemia with triamterene and oral potassium chloride has not improved the growth rate or patterns significantly, and the patients continue to remain below the third percentile during infancy, childhood, and early adolescence. One patient attained normal height and weight despite the absence of any treatment. Studies on the pituitary-adrenal axis show low basal 17-hydroxycorticosteroids and 17-ketosteroids with reduced adrenocorticotropic hormone reserve following metyrapone. Elevated plasma insulin levels (at zero time, the patients' values ranged from 18 to 38 μU per milliliter; normal 10±2 S.D.) were found in all patients with or without abnormal glucose tolerance. The patients exhibited sensitivity to insulin and hypoglycemic unresponsiveness despite increased levels of plasma growth hormone (peak values 35 and 84 ng. per milliliter in the patients; normal 15.5±9.5 S.D.).