Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions


Answer 3
  1. Cortisol. Excessive consumption of licorice causes the syndrome of apparent mineralocorticoid excess. It manifests as hypertension, hypokalemia, and metabolic alkalosis. Licorice contains glycyrrhetinic acid, a substance that inhibits 11ß-hydroxysteroid dehydrogenase. This enzyme normally functions to convert cortisol to cortisone. This is important because cortisol avidly binds the mineralocorticoid receptor in the collecting tubules of the kidney, mimicking aldosterone’s effects (ie, salt retention, potassium excretion). Cortisone is unable to bind the receptor. In patients in whom this enzyme is inhibited, cortisol is not converted to cortisone, inducing a syndrome that presents similarly to mineralocorticoid excess. Aldosterone levels in this situation are suppressed and therefore do not cause hypertension. Dihydrotestosterone and progesterone are not metabolized by 11ß-hydroxysteroid dehydrogenase and have no effect on the mineralocorticoid receptor.

     Brewster UC, Setaro JF, Perazella MA. The renin-angiotensin-aldosterone system: cardiorenal effects and implications of renal and cardiovascular disease states. Am J Med Sci 2003;326:15–24.

    2. Cruz DN, Perazella MA. Hypertension and hypokalemia: unusual syndromes. Connecticut Med 1997;61:67–75.

Click here to return to the questions


Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj