Licorice extract contains glycyrrhizinic acid which when taken chronically can result in a syndrome mimicking mineralocorticoid excess.
Glycyrrhetenic acid (the metabolite of glycyrrhizinic acid) inactivates 11-beta-hydroxysteroid dehydrogenase. This enzyme inactivates cortisol, and its inactivation results in a cortisol excess that results in stimulation of mineralocorticoid receptors.
Products containing licorice extracts (de Klerk et al, page 732):
The licorice-containing product should be taken daily. Some people may be very sensitive to the licorice and only a small amount is sufficient to produce the syndrome. For these it is very easy to overlook the inciting source. Others may ingest large quantities of the licorice-containing product.
Clinical findings:
(1) hypertension
(2) hypokalemia
(3) hypernatremia and edema
(4) metabolic alkalosis
The person should return to normal when the licorice product is discontinued.
The workup may include determining the ratio of urinary metabolites of cortisone to those of cortisol.
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