Endocrine Abstracts

Introduction: Excessive consumption of liquorice can cause endocrine symptoms of apparent mineralocorticoid excess (AME). This is usually caused by excessive consumption of liquorice-containing sweets and native liquorice root but the different chemical compounds in liquorice may also be used in many other products where it is considered an additive and therefore not explicitly declared.

Case: We here report a 21-year-old patient who exhibited severe symptoms of AME (oedema, spells of dizziness, headaches and peripheral paraesthesia as well as general and muscular fatigue) due to inadvertent excessive intake of liquorice. Blood samples showed low serum potassium (2.3–3.1 mmol/l, ref (3.5–4.6)) requiring potassium supplementation (40 mmol×2 daily) and high normal sodium (142–147 mmol/l, ref (137–145)). Measurement of 24 h urinary steroid metabolite excretion raised the suspicion of AME. Additional blood tests showed undetectable serum concentrations of aldosterone (<38 pmol/l, ref (50–360)) and renin (<2*10⁻³ IU/l, ref (6–60)). Pituitary function (thyroid hormones, prolactin, IGF1, IGFBP3) was normal. No obvious endocrine cause of AME could be established and the patient re-evaluated all personal dietary products. Liquorice root was present in several herbal teas and sugar-free chewing gum that had been consumed daily in large amounts. Cessation of usage of these products resulted in complete recovery of AME-related symptoms.

Conclusions: Our case report revealed other potential sources of liquorice than sweets including industrial sweeteners and flavouring agents that could potentially cause clinical symptoms. Clinicians should thus extend their medical history to a broader range of consumer products when suspecting AME.