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Pituitary Microadenoma in the Posterior Pituitary Gland
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Mar 24, 2026
  • Diagnosis Title: Coexisting Bartter Syndrome and Cushing's Disease due to Pituitary Microadenoma
  • Disease Specialty: Nephrology
  • Ease of Diagnosis: Difficult
  • Certainty: Certain
  • Ethnicity: Asian
  • Segment: Adult Female
  • Image Quality: Medium
  • Clinical Examination: The patient exhibited proximal muscle weakness in all limbs, cushingoid facies, emotional lability, and was normotensive and euvolemic on presentation.
  • Patient Age: 38 year
  • Patient Gender: Female

    •  A 38-year-old female presented with vertigo, abdominal distension, weakness in all limbs, and facial edema. She had recurrent quadriparesis, polyuria, and new-onset T2DM. Labs showed hypokalemia (1.9 meq/L), metabolic alkalosis (pH 7.51, HCO₃ 35.8), normotension (BP 100/64 mmHg), and cushingoid facies. Urine tests indicated kaliuresis and hypercalciuria, confirming adult-onset Bartter syndrome. Elevated cortisol (56.5 mcg/dL) and ACTH (138 pg/mL) with pituitary microadenoma on MRI suggested Cushing's disease. Treated with K⁺ supplements, spironolactone, indomethacin, and transsphenoidal surgery. Genetic testing revealed Bartter syndrome type 4b (CLCNKA and CLCNKB mutations).

    MRI
    MRI shows a pituitary microadenoma (yellow arrow) in the posterior pituitary.
    MRI shows a pituitary microadenoma (yellow arrow) in the posterior pituitary.