Journal of Clinical Case Reports

Coronary Artery Spasm, Hypertension, Hypokalemia and Licorice

Abstract

Ewa Konik, Emily Graham Kurtz, Flora Sam and Douglas Sawyer

Hypertension with hypokalemia, especially in a patient off diuretics, suggests a secondary hypertension due to an increase in mineralocorticoid activity, for example, primary increases in renin, aldosterone, or nonaldosterone mineralocorticoid secretion or an increased mineralocorticoid-like effect.
Mineralocorticoid Receptors (MR) preferentially bind cortisol. A mineralocorticoid effect of cortisol is avoided in some tissues by expression of 11-Beta Hydroxysteroid Dehydrogenase type 2 (11 BHSD2), the enzyme responsible for transformation of cortisol to its 11-keto derivative (cortisone), which has minimal affinity for MR receptors. Only when cortisol is converted to the inactive cortisone can aldosterone bind to the MR. Rare congenital deficiency of 11 BHSD2 or its inhibition by licorice consumption mimics hyperaldosteronic state.