Pseudohyperaldosteronism, liquorice, and hypertension - PubMed (original) (raw)

Case Reports

Pseudohyperaldosteronism, liquorice, and hypertension

Bruno Sontia et al. J Clin Hypertens (Greenwich). 2008 Feb.

Abstract

Consumption of large quantities of liquorice can cause hypokalemia and hypertension. These effects are associated with increased cortisol-mediated activation of renal mineralocorticoid receptors and hypoaldosteronism. The authors describe a patient with long-standing hypokalemia and uncontrolled hypertension related to excessive ingestion of liquorice. The case highlights the importance of obtaining a detailed dietary history, especially considering the increasing use of liquorice-containing foods, teas, and herbal products. The authors also discuss secondary causes of hypertension, focusing on pseudohyperaldosteronism.

PubMed Disclaimer

Figures

Figure

Figure

Schematic demonstrating mechanisms whereby liquorice induces hypertension. Liquorice contains glycyrrhizin, which is converted to glycyrrhetinic acid in the bowel. Glycyrrhetinic acid inhibits activation of 11β‐hydroxysteroid dehydrogenase 2 (11β‐HSD2), an enzyme that converts active cortisol to inactive cortisone. 11β‐HSD2 is expressed in the renal cortex and the salivary glands. Decreased activation of 11β‐HSD2 results in elevated cortisol levels and increased binding to renal mineralocorticoid receptors. Mineralocorticoid receptor activation leads to Na+ reabsorption and renal K+ loss and consequent hypernatremia and hypokalemia. This is associated with elevated blood pressure. Liquorice (glycyrrhizin) may also inhibit the renin‐angiotensin‐aldosterone system (RAAS) by reducing renin secretion. ↑ indicates increase effect; ↓, decrease effect.

Similar articles

Cited by

References

    1. Farese RV Jr, Biglieri EG, Shackleton CH, et al. Licorice‐induced hypermineralocorticoidism. N Engl J Med. 1991;325(17):1223–1227. - PubMed
    1. Mumoli N, Cei M. Licorice‐induced hypokalemia. Int J Cardiol. 2007 Feb 21; [Epub ahead of print]. - PubMed
    1. Van Uum SH. Liquorice and hypertension. Neth J Med. 2005;63(4):119–120. - PubMed
    1. Palermo M, Quinkler M, Stewart PM. Apparent mineralocorticoid excess syndrome: an overview. Arq Bras Endocrinol Metabol. 2004;48(5):687–696. - PubMed
    1. Van Uum SH, Lenders JW, Hermus AR. Cortisol, 11beta‐hydroxysteroid dehydrogenases, and hypertension. Semin Vasc Med. 2004;4(2):121–128. - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources