Is glycyrrhizin sensitivity increased in anorexia nervosa and should licorice be avoided? Case report and review of the literature.
OBJECTIVE
Hypokalemia is a potentially life-threatening electrolyte disturbance in anorexia nervosa and is most frequently caused by purging behavior. We report a case of severe hypokalemia in anorexia nervosa induced by daily ingestion of approximately 20 g of licorice.


METHODS
To confirm the diagnosis of licorice-induced pseudohyperaldosteronism, a re-exposure trial was performed.


RESULTS
Cessation of the licorice intake normalized plasma potassium, renin, and aldosterone levels and the urine cortisol/cortisone ratio. Re-exposure confirmed the diagnosis. The pronounced response to a relatively low daily dose of licorice suggests high glycyrrhizin sensitivity.


CONCLUSIONS
Patients with anorexia nervosa not only have decreased food intake but also selective and sometimes bizarre eating habits that, in association with increased sensitivity to glycyrrhizin, may cause severe hypokalemia.
Støving
René K
RK
Center for Eating Disorders and Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark. rene.k.stoving@dadlnet.dk
Lingqvist
Linnéa E
LE
Bonde
Rasmus K
RK
Andries
Alin
A
Hansen
Marianne H
MH
Andersen
Marianne
M
Hørder
Kirsten
K
D000293:Adolescent; D000450:Aldosterone / Q000097:blood; D000856:Anorexia Nervosa / Q000097:blood / Q000150:complications*; D003348:Cortisone / Q000652:urine; D005260:Female; D006035:Glycyrrhiza / Q000009:adverse effects / Q000737:chemistry*; D019695:Glycyrrhizic Acid / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D006929:Hyperaldosteronism; D007008:Hypokalemia / Q000097:blood / Q000139:chemically induced*; D010936:Plant Extracts / Q000009:adverse effects*; D011188:Potassium / Q000097:blood* / Q000652:urine; D012083:Renin / Q000097:blood
D010936:Plant Extracts; D000450:Aldosterone; D019695:Glycyrrhizic Acid; D012083:Renin; D011188:Potassium; D003348:Cortisone; D006854:Hydrocortisone