Liquorice, growth retardation and Addison's disease.
An 11-year-old boy had hypoparathyroidism and Addison's disease. During treatment with calcitriol, calcium, hydrocortisone and 9-alpha-fluorocortisol, he developed an apparent mineralocorticoid excess and growth retardation. Pseudohyperaldosteronism even persisted after treatment with 9-alpha-fluorocortisol was stopped and hydrocortisone was reduced to 6 mg/m(2). The boy reported an excessive daily intake of 300-400 g liquorice corresponding to 600-800 mg glycyrrhizic acid because of salt craving. After complete withdrawal of liquorice all symptoms of hypermineralocorticoidism diminished and growth velocity increased. We hypothesise that inhibition of 11beta-hydroxysteroid dehydrogenase by liquorice caused hypermineralocorticoidism and growth retardation via increased levels of free cortisol in this patient. We conclude that self-medication with liquorice in children with Addison's disease should be considered during treatment.
Doeker
B M
BM
Department of Endocrinology, Vestische Kinderklinik Datteln, University of Witten-Herdecke, Germany. Beate_Maria_Doeker@yahoo.com
Andler
W
W
D042842:11-beta-Hydroxysteroid Dehydrogenases; D000224:Addison Disease / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D001827:Body Height; D001835:Body Weight; D002648:Child; D004791:Enzyme Inhibitors / Q000009:adverse effects; D005438:Fludrocortisone / Q000627:therapeutic use; D006035:Glycyrrhiza / Q000009:adverse effects*; D006130:Growth Disorders / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D006913:Hydroxysteroid Dehydrogenases / Q000037:antagonists & inhibitors; D008297:Male; D008901:Mineralocorticoids / Q000378:metabolism / Q000627:therapeutic use; D010946:Plants, Medicinal
D004791:Enzyme Inhibitors; D008901:Mineralocorticoids; D006913:Hydroxysteroid Dehydrogenases; D042842:11-beta-Hydroxysteroid Dehydrogenases; D005438:Fludrocortisone