Endocrine Abstracts

Liquorice (scientific name Glycyrrhiza glabra) is historically used for gastrointestinal complaints. Now it is primarily used as a flavoring agent in the tobacco, confectionery and to some extent in the pharmaceutical and beverage industries. Excessive intake of liquorice may cause a primary hyperaldosteronism-like syndrome characterized by sodium and water retention, hypertension, hypokalaemia, metabolic alkalosis, low-renin activity, and hypoaldosteronism. We describe a 69 years old lady who presented through a General Practitioner with hypertension, dependent oedema and hypokalaemia. There was no history of diarrhoea or vomiting and diuretics or laxative use. She was an ex smoker and consumed a bottle of wine per week Her bloods showed severe hypokalaemia with potassium of 2.0 mmol/l. Her arterial pH was 7.50 with bicarbonate 42 mmol/l (metabolic alkalosis). Her serum renin and aldosterone were both low. Her Serum TSH, overnight dexamethasone suppression, ultrasound scan of the kidneys and 24 h urinary calcium were normal. Her history was reviewed once again and at that time it revealed that she had been taking liquorice in sweets for as long as she could remember. She stopped liquorice after that admission and was discharged home on oral potassium supplements Sando K, two tablets three times a day which she gradually reduced and was not on any potassium supplements for about two months when seen in out patients, She was normotesive, had no dependent oedema and her serum potassium was normal. The case emphasizes the importance of considering a detailed patient’s history, which often may lead the treating physician to the correct clinical diagnosis.