PDF(Pubmed)
Abstract：
BACKGROUND: Syndrome of apparent mineralocorticoid excess (AME) is characterized by excessive MR stimulation despite low levels of aldosterone. 11Beta-hydroxysteroid dehydrogenase-2 (11βDSH-2) inactivates cortisol to cortisone, preventing cortisol-induced MR activation. Genetic defects in 11βDSH-2 cause AME through accumulation of cortisol in the distal nephron, leading to MR activation induced hypertension, hypokalemia and metabolic alkalosis. Acquired AME can occur due to the ingestion of glycyrrhizic acid, found in licorice root, which inhibits 11βDSH-2 and has additional effects on cortisol homeostasis through inhibition of 11βDSH-1.
METHODS: We present a case of acquired AME with a hyperadrenergic symptoms induced by ingestion of Advanced Liver Support, a nutritional supplement produced by Advanced BioNutritionals(R), in a 65-year-old Caucasian female who presented with accelerated hypertension, hypokalemia, metabolic alkalosis and adrenergic symptoms. Cessation of the licorice-containing supplement resulted in complete resolution of the patient\'s hypertension, symptoms and abnormal lab values. To our knowledge this is the first reported case of AME from this supplement, and the first to describe accompanying hyperadrenergic symptoms.
CONCLUSIONS: Glycyrrhizic acid is increasingly being found in unregulated nutritional supplements and has the potential to induce a reversable syndrome of AME. Acquired AME should be suspected in individuals who present with hypertension along with hypokalemia, metabolic alkalosis and low plasma renin and serum aldosterone levels.
METHODS: We present a case of acquired AME with a hyperadrenergic symptoms induced by ingestion of Advanced Liver Support, a nutritional supplement produced by Advanced BioNutritionals(R), in a 65-year-old Caucasian female who presented with accelerated hypertension, hypokalemia, metabolic alkalosis and adrenergic symptoms. Cessation of the licorice-containing supplement resulted in complete resolution of the patient\'s hypertension, symptoms and abnormal lab values. To our knowledge this is the first reported case of AME from this supplement, and the first to describe accompanying hyperadrenergic symptoms.
CONCLUSIONS: Glycyrrhizic acid is increasingly being found in unregulated nutritional supplements and has the potential to induce a reversable syndrome of AME. Acquired AME should be suspected in individuals who present with hypertension along with hypokalemia, metabolic alkalosis and low plasma renin and serum aldosterone levels.
摘要：
背景：尽管醛固酮水平较低，但明显盐皮质激素过量（AME）综合征的特征是MR刺激过度。11β-羟基类固醇脱氢酶-2（11βDSH-2）使皮质醇失活为可的松，防止皮质醇诱导的MR激活。11βDSH-2的遗传缺陷通过皮质醇在远端肾单位的积累引起AME，导致MR激活诱发的高血压，低钾血症和代谢性碱中毒。获得的AME可能由于摄入甘草酸而发生，在甘草根中发现，抑制11βDSH-2，并通过抑制11βDSH-1对皮质醇稳态有额外影响。
方法：我们介绍了一例因摄入高级肝脏支持而引起的具有高肾上腺素能症状的获得性AME，由高级生物营养品（R）生产的营养补充剂，在一名65岁的白人女性中，她出现了加速的高血压，低钾血症,代谢性碱中毒和肾上腺素能症状。停用含甘草的补充剂可完全缓解患者的高血压，症状和异常实验室值。据我们所知，这是第一例报告的AME病例，也是第一个描述伴随的高肾上腺素能症状的人。
结论：甘草酸越来越多地存在于未调节的营养补充剂中，并有可能诱发AME逆转综合征。患有高血压和低钾血症的个体应怀疑获得性AME，代谢性碱中毒和低血浆肾素和血清醛固酮水平。
方法：我们介绍了一例因摄入高级肝脏支持而引起的具有高肾上腺素能症状的获得性AME，由高级生物营养品（R）生产的营养补充剂，在一名65岁的白人女性中，她出现了加速的高血压，低钾血症,代谢性碱中毒和肾上腺素能症状。停用含甘草的补充剂可完全缓解患者的高血压，症状和异常实验室值。据我们所知，这是第一例报告的AME病例，也是第一个描述伴随的高肾上腺素能症状的人。
结论：甘草酸越来越多地存在于未调节的营养补充剂中，并有可能诱发AME逆转综合征。患有高血压和低钾血症的个体应怀疑获得性AME，代谢性碱中毒和低血浆肾素和血清醛固酮水平。
