• W Caré, G Grenet, C Schmitt, S Michel, J Langrand, G Le Roux, and D Vodovar.
• Centre antipoison de Paris, Fédération de toxicologie (FeTox), hôpital Fernand-Widal (AP-HP), 200, rue du faubourg Saint-Denis, 75010 Paris, France; Service de médecine interne, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 91460 Saint-Mandé, France; Université Paris Cité, Inserm UMR-S 1144, optimisation thérapeutique en neuropsychopharmacologie, 75006 Paris, France. Electronic address: weniko.care@aphp.fr.
• Rev Med Interne. 2023 Sep 1; 44 (9): 487494487-494.

AbstractThe word "licorice" refers to the plant, its root, and its aromatic extract. From a commercial point of view, Glycyrrhiza glabra is the most important species with a wide range of uses (herbal medicine, tobacco industry, cosmetics, food and pharmaceutical). Glycyrrhizin is one of the main constituents of licorice. Glycyrrhizin is hydrolyzed in the intestinal lumen by bacterial β-glucuronidases to 3β-monoglucuronyl-18β-glycyrrhetinic acid (3MGA) and 18β-glycyrrhetinic acid (GA), which are metabolized in the liver. Plasma clearance is slow due to enterohepatic cycling. 3MGA and GA can bind to mineralocorticoid receptors with very low affinity, and 3MGA induces apparent mineralocorticoid excess syndrome through dose-dependent inhibition of 11β-hydroxysteroid dehydrogenase type 2 in renal tissue. The cases of apparent mineralocorticoid excess syndrome reported in the literature are numerous and sometimes severe, even fatal, most often in cases of chronic high dose consumption. Glycyrrhizin poisonings are characterized by hypertension, fluid retention, and hypokalemia with metabolic alkalosis and increased kaliuresis. Toxicity depends on the dose, the type of product consumed, the mode of consumption (acute or chronic) and a very large inter-individual variability. The diagnosis of glycyrrhizin-induced apparent mineralocorticoid excess syndrome is based on the history, clinical examination, and biochemical analysis. Management is primarily based on symptomatic care and stopping licorice consumption.Copyright © 2023 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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