{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T11:02:06Z","timestamp":1787742126606,"version":"build-2784847793"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:00:00Z","timestamp":1722988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:00:00Z","timestamp":1722988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Syndrome of apparent mineralocorticoid excess (AME) is characterized by excessive MR stimulation despite low levels of aldosterone. 11Beta-hydroxysteroid dehydrogenase-2 (11\u03b2DSH-2) inactivates cortisol to cortisone, preventing cortisol-induced MR activation. Genetic defects in 11\u03b2DSH-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 11\u03b2DSH-2 and has additional effects on cortisol homeostasis through inhibition of 11\u03b2DSH-1.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case report<\/jats:title>\n                <jats:p>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<jats:sup>(R)<\/jats:sup>, 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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-024-04674-1","type":"journal-article","created":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:02:12Z","timestamp":1722988932000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Glycyrrhizic acid induced acquired apparent mineralocorticoid excess syndrome with a hyperadrenergic state: a case report"],"prefix":"10.1186","volume":"18","author":[{"given":"John","family":"Szendrey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Poindexter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Braden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,8,7]]},"reference":[{"issue":"2","key":"4674_CR1","doi-asserted-by":"publisher","first-page":"R11","DOI":"10.1016\/0303-7207(94)90176-7","volume":"105","author":"AL Albiston","year":"1994","unstructured":"Albiston AL, Obeyesekere VR, Smith RE, Krozowski ZS. Cloning and tissue distribution of the human 11 beta-hydroxysteroid dehydrogenase type 2 enzyme. Mol Cell Endocrinol. 1994;105(2):R11-17.","journal-title":"Mol Cell Endocrinol"},{"key":"4674_CR2","doi-asserted-by":"crossref","unstructured":"Roland BL, Krozowski ZS, Funder JW. Glucocorticoid receptor, mineralocorticoid receptors, 11 beta-hydroxysteroid dehydrogenase-1 and -2 expression in rat brain and kidney: in situ studies. Mol Cell Endocrinol. 1995111(1):R1-7.","DOI":"10.1016\/0303-7207(95)03559-P"},{"issue":"3","key":"4674_CR3","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1210\/endo.137.3.8603583","volume":"137","author":"BL Roland","year":"1996","unstructured":"Roland BL, Funder JW. Localization of 11beta-hydroxysteroid dehydrogenase type 2 in rat tissues: in situ studies. Endocrinology. 1996;137(3):1123\u20138.","journal-title":"Endocrinology"},{"issue":"1","key":"4674_CR4","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1161\/01.HYP.0000224296.96235.dd","volume":"48","author":"ZH Zhang","year":"2006","unstructured":"Zhang ZH, Kang YM, Yu Y, Wei SG, Schmidt TJ, Johnson AK, et al. 11beta-hydroxysteroid dehydrogenase type 2 activity in hypothalamic paraventricular nucleus modulates sympathetic excitation. Hypertension. 2006;48(1):127\u201333.","journal-title":"Hypertension"},{"issue":"4812","key":"4674_CR5","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1126\/science.3037703","volume":"237","author":"JL Arriza","year":"1987","unstructured":"Arriza JL, Weinberger C, Cerelli G, Glaser TM, Handelin BL, Housman DE, et al. Cloning of human mineralocorticoid receptor complementary DNA: structural and functional kinship with the glucocorticoid receptor. Science. 1987;237(4812):268\u201375.","journal-title":"Science"},{"issue":"11","key":"4674_CR6","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1016\/0024-3205(94)90042-6","volume":"55","author":"M Bernardi","year":"1994","unstructured":"Bernardi M, D\u2019Intino PE, Trevisani F, Cantelli-Forti G, Raggi MA, Turchetto E, et al. Effects of prolonged ingestion of graded doses of licorice by healthy volunteers. Life Sci. 1994;55(11):863\u201372.","journal-title":"Life Sci"},{"issue":"6","key":"4674_CR7","doi-asserted-by":"publisher","first-page":"465","DOI":"10.3109\/07853890.2010.499133","volume":"42","author":"HE Miettinen","year":"2010","unstructured":"Miettinen HE, Piippo K, Hannila-Handelberg T, Paukku K, Hiltunen TP, Gautschi I, et al. Licorice-induced hypertension and common variants of genes regulating renal sodium reabsorption. 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Diabetes. 2004;53:2051\u20139.","journal-title":"Diabetes"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-024-04674-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-024-04674-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-024-04674-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:02:17Z","timestamp":1722988937000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-024-04674-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,7]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4674"],"URL":"https:\/\/doi.org\/10.1186\/s13256-024-04674-1","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,7]]},"assertion":[{"value":"17 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no conflicts of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"358"}}