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Yıl:2020; Cilt: 31; Sayı: 1>> Özet
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Türk Psikiyatri Dergisi; 2020;31(1):69-73
Psikiyatri Kliniğinde Tanı Konulan Anoreksiya Nervoza Görünümlü Gitelman Sendromu
GK Sinanoğlu, M Aydın
Selçuk Üniversitesi, Konya
Anoreksiya nervoza vücut ağırlığı ve biçimi ile aşırı zihinsel uğraşın olduğu, kilo alma korkusu nedeniyle bilinçli olarak zayıf kalma çabaları ile giden bir bozukluktur. Anoreksiya nervoza hastalarının zayıf kalmak için kullandıkları yöntemlerden biri olan kusma hipokaleminin en önemli sebeplerinden birisidir. Diüretik kullanımı ve diyare hipokaleminin sık karşılaşılan diğer nedenleri arasındadır. Hipokalemi kronik ve tedaviye dirençli ise yeme bozuklukları ve diğer metabolik durumlar araştırılmalıdır. Gitelman sendromu hipokaleminin nadir görülen sebeplerinden birisidir. Gitelman sendromu klinik olarak hastalarda kusma ile giden ve hipokalemi, metabolik alkaloz, hipokalsiüri, hipomagnezemi görülen distal tübüllerin genetik geçişli bir hastalığıdır. Sıklıkla adolesan dönemde tanı koyulan, bazen ömür boyu asemptomatik seyredebilen bir sendromdur. Kas zayıflığı, halsizlik, yorgunluk, kramp veya karpopedal spazm gibi belirtiler görülür. Nadiren tetani, rabdomiyoliz ve paralizi gibi ciddi belirtiler de görülebilir. Bu yazıda fiziksel görünümü, vücut kitle indeksinin (VKİ) düşük olması, sık sık kusmalarının olması ile anoreksiya nervoza tanısı almış; diğer tıbbi patolojiler yeterince araştırılmamış olan bir Gitelman sendromu vakası sunulmaktadır. Psikiyatrik bozuklukların tanısı konulmadan önce, belirtiler ile ilişkili olabilecek tıbbi durumları dışlamak için tıbbi değerlendirmeler yapılması önemlidir
A Case of Gitelman Syndrome Diagnosed with Anorexia Nervosa in a Psychiatry Clinic
Anorexia nervosa is a disorder that is characterized by excessive preoccupation with body weight and shape, and conscious attempts to stay in low weight due to fear of weight gain. Vomiting, one of the methods used by anorexia nervosa patients to stay in low weight, is one of the most important causes of hypokalemia. Diuretics and diarrhea are other common causes of hypokalemia. If hypokalemia is chronic and resistant to treatment, eating disorders and other metabolic conditions should be investigated. One of the rare causes of hypokalemia, an electrolyte imbalance that can cause fatal outcomes, is Gitelman syndrome. Gitelman Syndrome is a genetically inherited disease of the distal tubules which causes hypokalemia, metabolic alkalosis, hypocalcemia, hypomagnesemia and vomiting. It is a syndrome usually diagnosed during adolescence, however it sometimes remains asymptomatic throughout life. Severe symptoms such as tetanus, rhabdomyolysis, and paralysis can also be seen. A case of Gitelman syndrome which was diagnosed as anorexia nervosa due to physical appearance of the patient, low body mass index (BMI), and frequent vomiting and in which the other medical pathologies have not been adequately investigated is presented in this article. Assessments to exclude the medical conditions that may be associated with symptoms are necessary before a diagnosis of a psychiatric disorder is made.

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