Licorice Edema

Chronic ingestion of licorice is reported to induce hypertension and hypokalemic metabolic alkalosis with low aldosterone and is therefore labeled pseudohyperaldosteronism. Edema alone is rarely described. Herein, we report a subject who presented with generalized edema and prehypertension with failure to detect the causative disorder despite evaluation by several consultants. A detailed interogation revealed onset of edema following use of chewing Tobacco for over 6 months after cessation of cigarette smoking. Prehypertension was noted on physical examination. Laboratory testing documented renal sodium retention with subnormal plasma renin activity and aldosterone as well as elevated both plasma and urinary cortisol/cortisone ratios indicating inhibition of renal 11-OHSD 2 enzyme and the active ingredients in licorice used to flavour chewing tobacco is well established to inhibit renal 11-OHSD 2 enzyme resulting in edema and prehypertension characterized as pseudohyperaldosteronism. Finally, remission of edema and reversal to normal blood pressure on abstinence from chewing tobacco confirms role of licorice in induction of edema in this subject