Objective: Licorice consumption is known to induce pseudo-hyperaldosteronism due to the presence of glycyrrhizic acid. Despite public health prevention efforts, exposure to glycyrrhizic acid often remains unrecognized by patients (anise-flavored drinks, herbal teas and infusions, sweets, supplements). This study aims to evaluate the prevalence of masked or involuntary exposure to licorice in a population referred for secondary hypertension. Design and method: This was a retrospective, single-center, descriptive study. The study included patients referred to the Hypertension Excellence Center at Grenoble University Hospital, France, for the evaluation of secondary hypertension. Clinical, biochemical, and cardiovascular data were extracted from the patients’ electronic medical records. As part of the initial diagnostic workup, serum levels of glycyrrhetic acid (the active metabolite of glycyrrhizic acid) were measured. Glycyrrhetic acid levels were routinely quantified using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) with a detection limit of 0,5 ng/mL. Results: The study included 84 patients. At admission, 28% of patients presented with hypokalemia associated with inappropriate kaliuresis (superior to 20 mmol/L). The secondary hypertension workup identified 12 cases of primary hyperaldosteronism (14%). Urinary free cortisol was abnormal in five patients, but the dexamethasone suppression tests were normal. Among the total cohort, glycyrrhetic acid was detected in 30% of patients, including two patients whose final diagnosis of primary hyperaldosteronism was confirmed. Specifically, eight patients (9%) had trace amounts of glycyrrhetic acid, and 18 patients (21%) had serum concentrations superior to 1 ng/mL Conclusions: This is the first study to identify the presence of plasma glycyrrhetic acid in 30% of patients referred for a secondary hypertension workup. This high prevalence suggests that screening for serum glycyrrhetic acid should be systematically considered in this population.
REYNAUD et al. (Fri,) studied this question.