Endocrine Abstracts

Liquorice intake is an uncommon but familiar cause of hypokalaemia and hypertension. Liquorice tea is available over the counter as herbal tea to promote general wellbeing. This case report describes a 64-year-old male patient who presented to hospital with severe hypokalaemia and hypertension. During the in-patient stay, patient was managed with potassium replacement and anti-hypertensives (avoiding medications that interfere with endocrine investigations), investigations were initiated for suspected primary hyperaldosteronism and cortisol excess and referred to Endocrine clinic. During the endocrine clinic review, it was noted the investigations for primary hyperaldosteronism and cortisol excess were normal. Renin and Aldosterone levels on two occasions were normal and there was no suggestion of secondary hyperaldosteronism or renovascular causes. Patient had metabolic alkalosis and was needing eight Sando K tablets per day to maintain normal serum potassium levels. Further detailed clinical history specifically about liquorice was asked and patient reported taking liquorice tea 2-3 times per day for the past year. Patient was advised to stop liquorice intake and over the next week, Sando K dose was reduced and stopped. Patient continued to maintain normal serum potassium levels. Anti-hypertensives were also tapered and stopped over next four weeks and blood pressure remained normal. Prolonged and regular use of liquorice can result in hypokalaemia and hypertension. Liquorice acts on aldosterone-responsive tissues and inhibits 11β-hydroxysteroid dehydrogenase, which converts cortisol to cortisone. This leads to high levels of cortisol which activates mineralocorticoid receptors. Many times, patients do not realise or report liquorice use unless specifically asked for it. In recent times, our Endocrine team has come across two other cases of hypokalaemia and hypertension secondary to liquorice intake. Therefore, detailed history and direct questioning regarding liquorice intake is advisable in all patients with hypertension and hypokalaemia and would help avoid unnecessary investigations.