A rare case of apparent mineralocorticoid excess induced by chronic liquorice ingestion

Summary: Apparent mineralocorticoid excess (AME) syndrome is a rare condition caused by the inhibition of the renal enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2). The most common acquired cause is chronic liquorice ingestion. We report the case of a 61-year-old woman who developed profound hypokalaemia, metabolic alkalosis, and QT prolongation due to excessive liquorice tea consumption. This case underscores the importance of detailed dietary history in patients with unexplained electrolyte disturbances and demonstrates the potentially fatal cardiovascular consequences of a widely available herbal remedy. Learning points: Hypokalaemia may present subtly but can carry life-threatening risks. Apparent mineralocorticoid excess should be considered in patients with resistant hypokalaemia and unexplained hypertension. A thorough dietary and over-the-counter medication history is essential in the evaluation of electrolyte disorders. Liquorice, although natural, can exert potent physiological effects with severe clinical consequences.