Onverklaarbare therapieresistente hypokaliëmie bij een 63-jarige man

Abstract

Unexplained therapy-resistant hypokalemia in a 63-year-old man The clinical history of a 63-year-old Caucasian man with persistent hypokalemia, hypernatremia and arterial hypertension is described. No abnormalities could be identified in the medical history, nor in the clinical examination or additional technical investigations. A decreased renin plasma level and a rather low aldosterone plasma level were observed. By assessing the patient’s dietary habits, a frequent licorice intake was noted. This case is compatible with the clinical presentation of glycyrrhizin-mediated pseudohyperaldosteronism. Glycyrrhizin is a component of licorice root extract, which is found in the roots of the licorice plant. It is frequently used as a sweetener in various food products, such as licorice. Through various mechanisms, excessive consumption of glycyrrhizin provokes the clinical effects of hyperaldosteronism, but in the absence of increased aldosterone levels. Glycyrrhizin inhibits 11-beta-hydroxysteroid-dehydrogenase type 2, resulting in an increased concentration and binding of cortisol on the mineralocorticoid receptor. Furthermore, it has an inhibitory effect on 5-beta-reductase, which results in a decreased degradation of aldosterone in the liver and thus enhances the aldosterone effect. Glycyrrhizin also directly activates the mineralocorticoid receptor. Hence, the overstimulated mineralocorticoid receptor results in hypokalemia, hypernatremia and hypertension. The diagnosis can be made based on the clinical presentation and laboratory values ​​in both blood and urine samples. Potassium substitution combined with the cessation of licorice consumption resulted in the normalization of the laboratory results and a minor decrease in blood pressure. Excessive consumption of glycyrrhizin-containing products should therefore be avoided and be questioned in patients with persistent hypokalemia, hypernatremia and arterial hypertension.