Licorice Toxicity (Pseudo-Hyperaldosteronism)


Licorice toxicity (causing pseudo-hyperaldosteronism) refers to the overconsumption of natural licorice (NOT red licorice) which contains a compound called glycyrrhetic acid. Here are the important points to remember about this phenomenon.

  • Glycyrrhetic acid blocks the activity of 11β-hydroxysteroid dehydrogenase
  • 11β-hydroxysteroid dehydrogenase converts cortisol into cortisone in mineralocorticoid receptor-containing cells. This is done so that cortisol does not exhibit its mineralocorticoid activity in these cells (leading to pseudo-hyperaldosteronism).

Upon excessive ingestion of licorice/licorice products (and subsequent overload of glcyrrhetic acid) 11β-hydroxysteroid dehydrogenase will be largely inhibited. This will lead to the accumulation of cortisol within mineralocorticoid receptor-containing cells, leading to increased mineralocorticoid activity.

The net consequence will by pseudo-hyperaldosteronism characterized by:

  • Hypertension
  • Hypokalemia
  • Metabolic alkalosis

*This condition will not have elevated aldosterone levels! 

Page Updated: 02.21.2016