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Pseudohyperaldosteronism Due to Licorice: A Practice-Based Learning from a Case Series.

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|July 13, 2024
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Summary

Excessive licorice consumption can cause pseudohyperaldosteronism (PHA), leading to hypertension and hypokalemia. Awareness of this condition and careful dietary history are crucial for diagnosis and management.

Keywords:
11-hydroxysteroid dehydrogenasehypertensionhypokalemialicoricepseudohyperaldosteronism

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Area of Science:

  • Endocrinology
  • Toxicology

Background:

  • Pseudohyperaldosteronism (PHA) presents with hypertension, hypokalemia, and suppressed renin and aldosterone.
  • The most common cause of PHA is excessive licorice intake, mediated by glycyrrhetinic acid (GA).

Observation:

  • Glycyrrhetinic acid (GA) blocks 11-hydroxysteroid dehydrogenase type 2 and activates the mineralocorticoid receptor (MR).
  • Clinical manifestations of licorice-induced PHA typically resolve after discontinuing licorice, but effects can persist.
  • Accurate patient history is essential for diagnosing exogenous PHA and avoiding unnecessary investigations.

Findings:

  • Management of licorice-induced PHA is individualized based on patient factors and severity.
  • Mineralocorticoid excess symptoms may necessitate MR blockers and potassium supplementation.
  • GA is present in various consumer products, highlighting potential for widespread exposure.

Implications:

  • Increased awareness of exogenous PHA is needed to prevent risks associated with excess licorice consumption.
  • Physicians should consider licorice intake in patients presenting with unexplained hypertension and hypokalemia.
  • Caution is advised regarding licorice consumption, especially in individuals with comorbidities or on interacting medications.