SFEBES2026 Poster Presentations Adrenal and Cardiovascular (54 abstracts)
Too much of a good thing: an interesting case of resistant hypokalaemia and hypertension due chronic liquorice ingestion mimicking apparent mineralocorticoid syndrome
Fatma Khan 1 , Hannah Jarman 1 , Sumudu Bujawansa 1 , Samuel John Westall 1 , Heather Sullivan 1 , Tala Balafshan 1 , Ram Prakash Narayanan 1 , Mustakim Khandaker 2 & Ei Thuzar Aung 1
1Diabetes and Endocrinology Department, Whiston Hospital, Prescot, United Kingdom; 2Department of Nephrology, Whiston Hospital, Prescot, United Kingdom
Background: Liquorice is commonly consumed across the world as a sweet treat or in traditional medicines. One of the key compounds in liquorice is Glycyrrhizin, which is metabolised to Glycyrrhetinic acid, a potent inhibitor of 11-ß-hydroxysteroid dehydrogenase 2 enzyme (11-ß-HSD 2). This enzyme is essential for deactivating cortisol. Blocking the 11-ß-HSD2 enzyme results in increased activity of cortisol, which increases the stimulation of mineralocorticoid receptors in the kidneys. This results in increased sodium retention, potassium loss and raised blood pressure. This can mimic apparent mineralocorticoid excess (AME), a rare autosomal recessive monogenic disease.
Clinical case: A 55-year-old woman with a history of hypertension for 20 years and hypothyroidism presented to hospital with dizziness and headaches. On admission, she was found to be profoundly hypertensive, with a systolic blood pressure of >230mmHg. Her regular medications were Ramipril 10 mg, Levothyroxine 50 micrograms and Omeprazole 10 mg. Her bloods revealed metabolic alkalosis with sodium of 147 mmol/l and potassium of 2.0 mmol/l. Renin was 0.5 nmol/l/hr and aldosterone was <50 pmol/l. 9-am cortisol was normal. Genetic testing for renal tubulopathies and apparent mineralocorticoid syndrome was negative. Her hypokalaemia required several rounds of IV replacement. Spironolactone 100 mg and Doxazocin 6 mg was added to control her blood pressure. Further history taking revealed that she had been consuming about 10 liquorice candies a day, which she was advised to stop. Within just a few weeks her potassium normalised, and blood pressure improved. Spironolactone and Doxazocin were stopped, leaving her on Ramipril alone.
Learning points: This case demonstrated the importance of asking questions regarding an individual’s lifestyle and dietary intake. Awareness of liquorice consumption causing a clinical picture of mineralocorticoid excess will help clinicians to correctly identify the diagnosis and appropriately advise the patient.
Volume 117
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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