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Evidence-Based Complementary and Alternative Medicine
Volume 2011, Article ID 646540, 5 pages
Case Report

Herbal Medicine Containing Licorice May Be Contraindicated for a Patient with an HSD11B2 Mutation

1Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
2Daikakuji Clinic, Kobe University Graduate School of Medicine, Tottori, Japan
3Usuki Clinic, Kobe University Graduate School of Medicine, Kobe, Japan
4Department of Hospital Pharmacy, Kobe University Graduate School of Medicine, Japan
5Division of Applied Genome Science and Bioinformatics, Kobe University Graduate School of Medicine, Kobe, Japan
6Nishimoto Clinic, Nishinomiya, Japan

Received 18 August 2009; Accepted 9 November 2009

Copyright © 2011 Indra Sari Kusuma Harahap et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Licorice ingestion, as well as mutations in the HSD11B2 gene, 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 an HSD11B2 mutation 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 mutant HSD11B2 genes. 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, in HSD11B2. In conclusion, licorice ingestion is an environmental risk factor for hypertension or AME state in patients with a mutation in HSD11B2. Carrying a mutation in HSD11B2 is, conversely, a genetic risk factor for licorice-induced hypertension or AME state. Herbal medicine containing licorice may, therefore, be contraindicated in patients with an HSD11B2 mutation.