Liquorice-induced sodium retention. Merely an acquired condition of apparent mineralocorticoid excess? A case report.
Excessive ingestion of liquorice may result in sodium retention, hypertension, hypokalemia, and suppression of renin and aldosterone. Similarities between liquorice-induced effects and congenital apparent mineralocorticoid excess have recently been emphasized, as in both conditions, reduced activity of the enzyme 11 beta-hydroxysteroid dehydrogenase type 2 allows cortisol to act as a potent mineralocorticoid. We report a case of generalized edema without any increase in blood pressure, with biochemical and hormonal features of apparent mineralocorticoid excess, in a young woman who had been ingesting substantial amounts of liquorice for several years. Liquorice-induced wide-spread edema without hypertension in our patient, as well as in a few other cases previously reported, and the more common occurrence of edema associated with hypertension challenge the current explanation of liquorice syndrome as a purely acquired apparent mineralocorticoid excess. Indeed, in both congenital apparent and true mineralocorticoid excess, edema is typically absent, as a result of the sodium escape phenomenon. As pressure-natriuresis may be an essential mechanism accounting for the sodium escape phenomenon, some component of liquorice could partially or completely oppose the circulatory response that converts liquorice-induced sodium retention into blood pressure elevation. In patients with unexplained generalized edema and hypokalemia without hypertension, liquorice ingestion should be carefully investigated and the renin-aldosterone system should be assayed.
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II Divisione di Medicina Interna, Azienda Ospedaliera Santa Maria Nuova di Reggio Emilia.
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D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D004487:Edema / Q000097:blood / Q000209:etiology; D005260:Female; D006035:Glycyrrhiza / Q000009:adverse effects*; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000209:etiology*; D008901:Mineralocorticoids / Q000378:metabolism; D010946:Plants, Medicinal; D012964:Sodium / Q000652:urine
D008901:Mineralocorticoids; D012964:Sodium