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Liquorice-induced apparent mineralocorticoid excess — SCE Endocrinology MCQ

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HardAdrenalLiquorice-induced apparent mineralocorticoid excessSCE Endocrinology

A 52-year-old man has hypertension and hypokalaemia. Renin is suppressed, aldosterone is also suppressed and cortisol rhythm is normal. He drinks large quantities of liquorice tea daily for dyspepsia. What is the underlying pathophysiology?

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Correct answer: C — Inhibition of 11β-hydroxysteroid dehydrogenase type 2 causing cortisol-mediated mineralocorticoid receptor activation

Liquorice inhibits 11β-HSD2, allowing cortisol to activate mineralocorticoid receptors, producing apparent mineralocorticoid excess with low renin and low aldosterone. Primary aldosteronism would have high aldosterone. The pearl is that low-renin hypertension with hypokalaemia is not synonymous with Conn's syndrome.

Reference: Endocrine Society mineralocorticoid hypertension guidance, BNF