We expose
acase of a woman with
hypertension and hypokalemia. The differential diagnosis should include primary
hyperaldosteronism, diuretics or lazantes intake, secondary hyperaldosteronism.
In this patient, additional
tests performed show no cause of hormonal
disruption and the whole picture is due to a high intake of licorice. Glycyrrhetinic
acid, the active component of licorice, inhibits renal IIbeta-hydroxisteroid dehydrogenase.
This allows cortisol to stimulate mineralocorticoid receptors. Licorice ingestion
should be considered in the differential diagnosis of hypertension with hypokalemia.
References
[1]
J. W. Funder, R. M. Carey, C. Fardella, C. E. Gomez-Sanchez, F. Mantero, M. Stowasser, W. F. Young Jr. and V. M. Montori, “Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline,” Journal of Clinical Endocrinology & Metabolism, Vol. 93, No. 9, 2008, pp. 3266-3281. http://dx.doi.org/10.1210/jc.2008-0104
[2]
S. C. Murphy, S. Agger and P. M. Rainey, “Too Much of a Good Thing: A Woman with Hypertension and Hypokalemia,” Clinical Chemistry, Vol. 55, No. 12, 2009, pp. 2093-2096. http://dx.doi.org/10.1373/clinchem.2009.127506
[3]
P. C. White, T. Mune and A. K. Agarwal, “11-Beta-hydroxysteroid Dehydrogenase and the Syndrome of Apparent Mineralocorticoid Excess,” Endocrine Reviews, Vol. 18, No. 1, 1997, pp. 135-136. http://dx.doi.org/10.1210/er.18.1.135
[4]
Scientific Committee on Food, “Opinion of the Scientific Committee on Food on Glycyrrhizinic Acid and Its Ammonium Salt,” European Commission Heath and Consumer Protection Directorate General, Brussels, 2012.
[5]
H. A. Sigurjonsdottir, K. Manhem, M. Axelson and S. Wallerstedt, “Subjects with Essential Hypertension Are More Sensitive to the Inhibition of 11 Beta-HSD by Liquorice,” Journal of Human Hypertension, Vol. 17, 2003, pp. 125-131. http://dx.doi.org/10.1038/sj.jhh.1001504
