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Licorice-induced apparent mineralocorticoid excess compounded by excessive use of terbutaline and high water intake
  1. Laust Frisenberg Buhl1,
  2. Frederik Nørregaard Pedersen2,
  3. Marianne Skovsager Andersen2,
  4. Dorte Glintborg1
  1. 1 Department of Endocrinology, Odense University Hospital, Odense, Denmark
  2. 2 Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
  1. Correspondence to Laust Frisenberg Buhl, laust.frisenberg{at}


This case highlights the clinical course of a 54-year-old male patient presenting with hypertension and long-term refractory hypokalaemia. He reported long-term malaise, fatigue and physical discomfort. Diarrhoea, vomiting, over-the-counter drugs, dietary supplements and any kind of medical abuse were all denied. Physical examination was normal. Suppressed plasma renin activity along with a low aldosterone level and elevated urinary cortisone/cortisol metabolite excretion ratio raised the suspicion of apparent mineralocorticoid excess (AME). The patient started treatment with spironolactone, but serum potassium levels were persistently fluctuating and the patient was hospitalised for further evaluation. During hospitalisation, repeated medical history and diagnostic examinations revealed licorice-induced AME complicated by excessive use of terbutaline and massive water intake. Licorice discontinuation, reduction of terbutaline and normalisation of water intake led to fully normalised potassium levels. Despite careful clinical history and diagnostic work-up, hospitalisation may be necessary in selected patients with long-term hypokalaemia.

  • endocrine system
  • adrenal disorders
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  • Contributors All authors made equally substantial contributions to study design, data acquisition and interpretation of data. LFB and FNP drafted the manuscript primarily. DG contributed in the management of the patient. DG and MSA gave expert opinion. All authors have approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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