{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:54:27Z","timestamp":1753883667570,"version":"3.41.2"},"reference-count":16,"publisher":"The Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Apparent mineralocorticoid excess syndrome is a rare disorder that can be acquired through inhibition of the enzyme 11 \u03b2-hydroxysteroid dehydrogenase type 2 by various substances such as bile acids. We report the case of a 61-year-old woman presenting with painless jaundice. Computed tomography demonstrated a pulmonary as well as a pancreatic tumor, with multiple metastases and dilated bile ducts. Laboratory findings showed persistent hypokalemia despite aggressive enteral and parenteral supplementation, as well as hypertension, metabolic alkalosis, and elevated cholestasis enzymes. Urinary potassium excretion was inappropriately high. Plasma aldosterone concentration was 0.97\u2005ng\/dL (26.91\u2005pmol\/L) (reference range, 2.21-25.30\u2005ng\/dL [61.31-701.82\u2005pmol\/L]) and direct renin concentration was 3.9 mIU\/L (2.1\u2005ng\/L) (reference range, 4.4-46.1 mIU\/L [2.53-27.42\u2005ng\/L]). Endogenous hypercortisolism was ruled out. After the placement of a metal biliary stent via endoscopic retrograde cholangiopancreatography and the subsequent decrease in cholestasis enzyme levels, potassium levels, hypertension, and metabolic alkalosis gradually normalized. The case was ultimately diagnosed as apparent mineralocorticoid excess syndrome resulting from 11 \u03b2-hydroxysteroid dehydrogenase type 2 inhibition caused by elevated bile acids secondary to malignant obstruction of the biliary tract.<\/jats:p>","DOI":"10.1210\/jcemcr\/luaf026","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T12:05:10Z","timestamp":1739793910000},"source":"Crossref","is-referenced-by-count":0,"title":["An Unusual Cause of Hypokalemia to Consider"],"prefix":"10.1210","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7325-1153","authenticated-orcid":false,"given":"In\u00e9s","family":"Borrego-Soriano","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Universitario La Paz , Madrid 28046 ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanieli","family":"Hern\u00e1ndez-Perdomo","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario La Paz , Madrid 28046 ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bego\u00f1a","family":"Rivas","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario La Paz , Madrid 28046 ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Parra-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Universitario La Paz , Madrid 28046 ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d3scar","family":"Moreno-Dom\u00ednguez","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Universitario La Paz , Madrid 28046 ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Vega-Cabrera","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario La Paz , Madrid 28046 ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"issue":"A","key":"2025021712050441700_luaf026-B1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jsbmb.2016.03.010","article-title":"Apparent mineralocorticoid excess","volume":"165","author":"Funder","year":"2017","journal-title":"J Steroid Biochem Mol Biol"},{"issue":"3","key":"2025021712050441700_luaf026-B2","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1152\/physrev.00020.2012","article-title":"11 Beta hydroxysteroid dehydrogenases: intracellular gate-keepers of tissue glucocorticoid action","volume":"93","author":"Chapman","year":"2013","journal-title":"Physiol Rev"},{"issue":"2","key":"2025021712050441700_luaf026-B3","doi-asserted-by":"crossref","first-page":"R11","DOI":"10.1016\/0303-7207(94)90176-7","article-title":"Cloning and tissue distribution of the human 11 beta-hydroxysteroid dehydrogenase type 2 enzyme","volume":"105","author":"Albiston","year":"1994","journal-title":"Mol Cell Endocrinol"},{"key":"2025021712050441700_luaf026-B4","doi-asserted-by":"crossref","first-page":"105988","DOI":"10.1016\/j.jsbmb.2021.105988","article-title":"Modulation of 11 beta hydoxysteroid dehydrogenase functions by the cloud of endogenous metabolites in a local microenvironment: the glycyrrhetinic acid-like factor (GALF) hypothesis","volume":"214","author":"Morris","year":"2021","journal-title":"J Steroid Biochem Mol Biol"},{"issue":"11","key":"2025021712050441700_luaf026-B5","doi-asserted-by":"crossref","first-page":"3401","DOI":"10.3390\/molecules27113401","article-title":"The role of bile acids in the human body and in the development of diseases","volume":"27","author":"Shulpekova","year":"2022","journal-title":"Molecules"},{"issue":"1","key":"2025021712050441700_luaf026-B6","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1093\/ejendo\/lvad066","article-title":"European Society of Endocrinology clinical practice guidelines on the management of adrenal incidenalomas, in collaboration with the European network for the study of adrenal tumors","volume":"189","author":"Fassnacht","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"2025021712050441700_luaf026-B7","first-page":"1","volume-title":"Nefrolog\u00eda al d\u00eda","author":"de Sequera Ortiz","year":"2023"},{"issue":"4","key":"2025021712050441700_luaf026-B8","doi-asserted-by":"crossref","first-page":"R135","DOI":"10.1530\/EC-18-0109","article-title":"Hypokalemia: a clinical update","volume":"7","author":"Kardalas","year":"2018","journal-title":"Endocr Connect"},{"issue":"29","key":"2025021712050441700_luaf026-B9","doi-asserted-by":"crossref","first-page":"26286","DOI":"10.1074\/jbc.M201556200","article-title":"Chenodeoxycholic acid and deoxycholic acid inhibit 11beta-hydroxysteroid dehydrogenase type 2 and cause cortisol-induced transcriptional activation of the mineralocorticoid receptor","volume":"277","author":"Stauffer","year":"2002","journal-title":"J Biol Chem"},{"issue":"3","key":"2025021712050441700_luaf026-B10","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1002\/hep.510300303","article-title":"Inhibition of 11 beta hydroxysteroid dehydrogenase by bile acids in rats with cirrhosis","volume":"30","author":"Ackermann","year":"1999","journal-title":"Hepatology"},{"issue":"1","key":"2025021712050441700_luaf026-B11","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S0016-5085(98)70645-6","article-title":"Down- regulation of hepatic and renal 11 beta-hydrocysteroid dehydrogenase in rats with liver cirrhosis","volume":"114","author":"Escher","year":"1998","journal-title":"Gastroenterolofy"},{"issue":"6","key":"2025021712050441700_luaf026-B12","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/0039-128X(94)90001-9","article-title":"Possible endogenous regulators of steroid inactivating enzymes and glucocorticoid-induced Na+ retention","volume":"59","author":"Latif","year":"1994","journal-title":"Steroids"},{"issue":"4","key":"2025021712050441700_luaf026-B13","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1080\/07435809609043778","article-title":"Endogenous 11 beta-hydroxysteroid dehydrogenasa inhibitors and their role in glucocorticoid Na+ retention and hypertension","volume":"22","author":"Morris","year":"1996","journal-title":"Endocr Res"},{"issue":"9","key":"2025021712050441700_luaf026-B14","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1172\/JCI12745","article-title":"Reduced activity of 11 beta hydroxysteroid dehydrogenase in patients with colestasis","volume":"108","author":"Quattropani","year":"2001","journal-title":"J Clin Invest"},{"issue":"4","key":"2025021712050441700_luaf026-B15","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1002\/hep.21381","article-title":"Impaired 11 beta hydroxysteroid dehydrogenase contributes to renal sodium avidity in cirrhosis: hypothesis or fact?","volume":"44","author":"Frey","year":"2006","journal-title":"Hepatology"},{"issue":"3","key":"2025021712050441700_luaf026-B16","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1152\/physiolgenomics.00115.2018","article-title":"Role of gut metabolism of adrenal corticosteroids and hypertension: cues gut-cleansing antibiotics give us","volume":"51","author":"Morris","year":"2019","journal-title":"Physiol Genomics"}],"container-title":["JCEM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/3\/3\/luaf026\/61921630\/luaf026.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/3\/3\/luaf026\/61921630\/luaf026.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T12:05:16Z","timestamp":1739793916000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcemcr\/article\/doi\/10.1210\/jcemcr\/luaf026\/8017736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,10]]},"references-count":16,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,2,10]]}},"URL":"https:\/\/doi.org\/10.1210\/jcemcr\/luaf026","relation":{},"ISSN":["2755-1520"],"issn-type":[{"type":"electronic","value":"2755-1520"}],"subject":[],"published-other":{"date-parts":[[2025,3]]},"published":{"date-parts":[[2025,2,10]]},"article-number":"luaf026"}}