Herbal Medicine Containing Licorice May Be Contraindicated for a Patient with anHSD11B2Mutation

摘要

Licorice ingestion, as well as mutations in theHSD11B2gene, inhibits 11β-hydroxysteroid dehydrogenase type 2 (11βHSD2) enzyme activity, causing the syndrome of apparent mineral corticoid excess (AME). However, the combined effect of licorice ingestion and anHSD11B2mutation has never been reported, until now. In this study, we demonstrated that licorice ingestion can produce overt hypertension in an individual without medical history of hypertension who is heterozygous for wild-type and mutantHSD11B2genes. Our patient was a 51-year-old female with serious hypertension who had been taking herbal medicine containing licorice for more than one year. She was clinically diagnosed as having licorice intoxication, because she did not present with hypertension after ceasing the herbal medicine.Molecular analysis showed that she carried a missense mutation, c.40C>T, inHSD11B2. In conclusion, licorice ingestion is an environmental risk factor for hypertension or AME state in patients with a mutation inHSD11B2.Carrying a mutation inHSD11B2is, conversely, a genetic risk factor for licorice-induced hypertension or AME state. Herbal medicine containing licorice may, therefore, be contraindicated in patients with anHSD11B2mutation.