Pseudohyperaldosteronism due to mumijo consumption during pregnancy: a licorice-like syndrome

Abstract

Herbal supplements are widely used during pregnancy, although there are insufficient data regarding their efficacy and safety. Some of them have been associated with hypertension, including licorice, which induces the so called mineralocorticoid-excess syndrome, a clinical picture resembling to pseudohyperaldosteronism. This action is mediated via inhibition of 11-hydroxysteroid dehydrogenase type 2 (11-HSD2), leading to impaired inactivation of cortisol to cortisone, accumulation of cortisol, and finally to excessive mineralocorticoid activity, especially in the distal and cumulative tubule of kidneys. This syndrome is characterized by hypertension and hypokalemia. Herein, we report a case of a 37-year-old pregnant woman, who was referred from obstetrics department to our department due to persistent hypertension and hypokalemia. She consumed a herbal supplement called “mumijo” during the last 6 months. After a thorough diagnostic work-up, the diagnosis of a “licorice-like syndrome” due to mumijo consumption was made. Potassium supplementation at the acute phase and discontinuation of mumijo were the treatment of choice. This is the first report of pseudohyperaldosteronism due to mumijo consumption in literature. Clinicians should be aware of this side effect and this agent should be included in those causing pseudohyperaldosteronism. Besides all, our case highlights the undeniable value of a detailed medical history.

摘要

尽管关于其功效和安全性的数据不足, 草药制剂在怀孕期间仍被广泛使用。其中一些与高血压相关, 包括甘草, 其可诱导所谓的盐皮质激素过量综合征, 其临床表现类似于假性醛固酮增多症。该作用通过抑制11-羟基类固醇脱氢酶2型（11-HSD2）介导, 导致皮质醇失活（脱氢）转变为可的松的能力受损, 尤其是在肾脏的远端小管和集合管中皮质醇蓄积, 最终导致过度的盐皮质激素活性。该综合征的特征是高血压和低钾血症。本文我们报告了一例37岁的孕妇, 由于持续性高血压和低钾血症, 从产科转诊到我科。在过去的6个月里, 她食用了一种名为“mumijo”的草药补品。经过全面的检查, 我们给出了因mumijo摄入而发生的“甘草样综合征”的诊断。急性期的钾补充和mumijo的停用是首选治疗方法。 这是第一次在文献中报道因摄入mumijo引起的假性醛固酮增多症。临床医生应该意识到这种副作用, 这种药物应该包含在能导致假性醛固酮过多症的药物目录中。除此之外, 我们的案例突出了详细病史的无可否认的价值。

Keywords:

• Mumijo
• pseudohyperaldosteronism
• hypokalemia
• hypertension
• licorice

Disclosure statement

No potential conflict of interest was reported by the authors.