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Edema, Enigma: 11 B-Hydroxysteroid Dehydrogenase Type 2 Inhibition by Sweetener “Stevia”

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DOI: 10.4236/ojemd.2012.23007    3,504 Downloads   10,312 Views   Citations

ABSTRACT

Intrduction: Edema, Hypertension and Hypokalemia occur with inhibition of 11 B-Hydroxysteroid Dehydrogenase Type 2 (11B-HSD2) by chronic Licorice ingestion. However, a similar presentation following a chronic use of another commonly used sweetener “Stevia” is not reported. Objective: To document a first case report of a subject presenting with Edema, Prehypertension and Hypokalemia induced by 11B-HSD2 inhibition induced by chronic ingestion of sweetener stevia. Case Report: 32 year old Caucasian woman presented with generalized edema (feet, hands and face) of over 6 months. She was noted to also manifest Prehypertension (138/88 mmHg) and Hypokalemia (3.4 mM/l). Laboratory tests revealed decline in serum aldosterone and plasma renin activity, an increase in plasma cortisol/cortisone ratio. On persistent interrogation, patient admitted to daily consumption of sweetener stevia for over 9 months. All the presenting manifestations resolved with normalization of the laboratory tests on withdrawal of stevia. Conclusion: This case report indicates that chronic ingestion of sweetener stevia may induce edema, hypertension and hypokalemia via reduced conversion of cortisol into cortisone by inhibition of 11 B-Hydroxysteroid Dehydrogenase Type 2.

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S. Esmail and U. Kabadi, "Edema, Enigma: 11 B-Hydroxysteroid Dehydrogenase Type 2 Inhibition by Sweetener “Stevia”," Open Journal of Endocrine and Metabolic Diseases, Vol. 2 No. 3, 2012, pp. 49-52. doi: 10.4236/ojemd.2012.23007.

References

[1] S. Ulick and R. Tedde, “Pathogenesis of the Type 2 Variant of the Syndrome of Apparent Mineralocorticoid Excess,” Journal of Clinical Endocrinology and Metabolism, Vol. 70, No. 1, 1990, pp. 200-206. doi:10.1210/jcem-70-1-200
[2] M. Shimojo and P. M. Stewart, “Apparent Mineralocorticoid Excess Syndromes,” Journal of Endocrinological Investigation, Vol. 18, No. 7, 1995, pp. 518-532.
[3] R. C. Wilson, S. Nimkarn and M. I. New, “Apparent Mineralocorticoid Excess,” Trends in Endocrinology & Metabolism, Vol. 12, No. 3, 2001, pp. 104-111. doi:10.1016/S1043-2760(00)00356-8
[4] M. Quinkler and P. M. Stewart, “Hypertension and the Cortisol-Cortisone Shuttle,” Journal of Clinical Endocrinology and Metabolism, Vol. 88, No. 6, 2003, pp. 23842392. doi:10.1210/jc.2003-030138
[5] B. R. Walker, J. C. Campbell, R. Fraser, P. M. Stewart, C. R. Edwards, P. M. Stewart, et al., “Mineralocorticoid Activity of Liquorice: 11-Beta-Hydroxysteroid Dehydrogenase Deficiency, Comes of Age,” Lancet, Vol. 2, No. 8563, 1987, pp. 821-824.
[6] R. V. Farese Jr., E. G. Biglieri, C. H. Shackleton, I. Irony and R. Gomez-Fontes, “Licorice-Induced Hypermineralo Corticoidism,” The New England Journal of Medicine, Vol. 325, No. 17, 1991, pp. 1223-1227. doi:10.1056/NEJM199110243251706
[7] Y. Kageyama, H. Suzuki and T. Saruta, “Glycyrrhizin Induces Mineralocorticoid Activity through Alterations in Cortisol Metabolism in the Human Kidney,” Journal of Endocrinology, Vol. 135, No. 1, 1992, pp. 147-152. doi:10.1677/joe.0.1350147
[8] H. A. Sigurjonsdottir, J. Ragnarsson, L. Franzson and G. Sigurdsson, “Is Blood Pressure Commonly Raised by Moderate Consumption of Liquorice?” Journal of Hum Hypertens, Vol. 9, No. 5, 1995, pp. 345-348.
[9] B. R. Walker, J. C. Campbell, R. Fraser, P. M. Stewart and C. R. Edwards, “Mineralocorticoid Excess and Inhibition of 11 Beta-Hydroxysteroid Dehydrogenase in Patients with Ectopic ACTH Syndrome,” Clinical Endocrinology (Oxford), Vol. 37, No. 6, 1992, pp. 483-492. doi:10.1111/j.1365-2265.1992.tb01478.x
[10] P. M. Stewart, B. R. Walker, G. Holder, D. O’Halloran and C. H. Shackleton, “11 Beta-Hydroxysteroid Dehydrogenase Activity in Cushing’s Syndrome: Explaining the Mineralocorticoid Excess State of the Ectopic Adrenocorticotropin Syndrome,” Journal of Clinical Endocrinology and Metabolism, Vol. 80, No. 12, 1995, pp. 3617-3620. doi:10.1210/jc.80.12.3617
[11] M. Quinkler, S. Johanssen, C. Grossmann, V. B?hr, Müller, W. Oelkers and S. Diederich, “Progesterone Metabolism in the Human Kidney and Inhibition of 11 Beta-Hydroxysteroid Dehydrogenase Type 2 by Progesterone and Its Metabolites,” Journal of Clinical Endocrinology and Metabolism, Vol. 84, No. 11, 1999, pp. 41654171. doi:10.1210/jc.84.11.4165
[12] E. Schoof, M. Girstl, W. Frobenius, M. Kirschbaum, H. G. D?rr, W. Rascher and J. D?tsch, “Decreased Gene Expression of 11 Beta-Hydroxysteroid Dehydrogenase Type 2 and 15-Hydroxyprostaglandin Dehydrogenase in Human Placenta of Patients with Preeclampsia,” Journal of Clinical Endocrinology and Metabolism, Vol. 86, No. 3, 2001, pp. 1313-1317. doi:10.1210/jc.86.3.1313
[13] P. Heilmann, E. Buchheim, J. Wacker and R. Ziegler, “Alteration of the Activity of the 11 Beta-Hydroxysteroid Dehydrogenase in Pregnancy: Relevance for the Development of Pregnancy-Induced Hypertension?” Journal of Clinical Endocrinology and Metabolism, Vol. 86, No. 11, 2001, pp. 5222-5226. doi:10.1210/jc.86.11.5222
[14] B. Lanz, B. Kadereit, S. Ernst, K. Shojaati, M. Causevic, B. M. Frey, F. J. Frey and M. G. Mohaupt, “Angiotensin II Regulates 11 Beta-Hydroxysteroid Dehydrogenase Type 2 via AT2 Receptors,” Kidney International, Vol. 4, No. 3, 2003, pp. 970-977. doi:10.1046/j.1523-1755.2003.00192.x
[15] A. T. Stauffer, M. K. Rochat, B. Dick, F. J. Frey and A. Odermatt, “Chenodeoxycholic Acid and Deoxycholic Acid Inhibit 11 Beta-Hydroxysteroid Dehydrogenase Type 2 and Cause Cortisol-Induced Transcriptional Activation of the Mineralocorticoid Receptor,” The Journal of Biological Chemistry, Vol. 277, No. 29, 2002, pp. 2628626292. doi:10.1074/jbc.M201556200
[16] C. A. Carvajal, D. G. Romero, L. M. Mosso, A. A. González, C. Campino, J. Montero and C. E. Fardella, “Biochemical and Genetic Characterization of 11 Beta-Hydroxysteroid Dehydrogenase Type 2 in Low-Renin Essential Hypertensives,” Journal of Hypertension, Vol. 23, No. 1, 2005, pp. 71-77. doi:10.1097/00004872-200501000-00015
[17] R. M. Oliveira-Filho, O. A. Uehara, C. A. Minetti and L. B. Valle, “Chronic Administration of Aqueous Extract of Stevia Rebaudiana (Bert.) Bertoni in Rats: Endocrine Effects,” General Pharmacology, Vol. 20, No. 2, 1989, pp. 187-191. doi:10.1016/0306-3623(89)90013-X
[18] E. Koyama, K. Kitazawa, Y. Ohori, O. Izawa, K. Kakegawa, A. Fujino and M. Ui, “In Vitro Metabolism of the Glycosidic Sweeteners, Stevia Mixture and Enzymatically Modified Stevia in Human Intestinal Microflora,” Food and Chemical Toxicology, Vol. 41, No. 3, 2003, pp. 359374. doi:10.1016/S0278-6915(02)00235-1
[19] E. Koyama, N. Sakai, Y. Ohori, K. Kitazawa, O. Izawa, K. Kakegawa, A. Fujino and M. Ui, “Absorption and Metabolism of Glycosidic Sweeteners of Stevia Mixture and Their Aglycone, Steviol, in Rats and Humans,” Food and Chemical Toxicology, Vol. 41, No. 6, 2003, pp. 875-883. doi:10.1016/S0278-6915(03)00039-5
[20] M. S. Melis, “Effect of Crude Extract of Stevia Rebaudiana on Renal Water and Electrolytes Excretion,” Phytomedicine, Vol. 6, No. 4, 1999, pp. 247-250. doi:10.1016/S0944-7113(99)80016-6
[21] P. Chan, B. Tomlinson, Y. J. Chen, J. C. Liu, M. H. Hsieh and J. T. Cheng, “A Double-Blind Placebo-Controlled Study of the Effectiveness and Tolerability of Oral Stevioside in Human Hypertension,” British Journal of Clinical Pharmacology, Vol. 50, No. 3, 2000, pp. 215220. doi:10.1046/j.1365-2125.2000.00260.x
[22] M. H. Hsieh, P. Chan, Y. M. Sue, J. C. Liu, T. H. Liang, T. Y. Huang, B. Tomlinson, M. S. Chow, P. F. Kao and Y. J. Chen, “Efficacy and Tolerability of Oral Stevioside in Patients with Mild Essential Hypertension: A Two-Year, Randomized, Placebo-Controlled Study,” Clinical Therapeutics, Vol. 25, No. 11, 2003, pp. 2797-2808. doi:10.1016/S0149-2918(03)80334-X
[23] L. A. Ferri, W. Alves-Do-Prado, S. S. Yamada, S. Gazola, M. R. Batista and R. B. Bazotte, “Investigation of the Antihypertensive Effect of Oral Crude Stevioside in Patients with Mild Essential Hypertension,” Phytotherapy Research, Vol. 20, No. 9, 2006, pp. 732-726. doi:10.1002/ptr.1944
[24] K. C. Maki, L. L. Curry, M. C. Carakostas, S. M. Tarka, M. S. Reeves, M. V. Farmer, J. M. McKenney, P. D. Toth, S. L. Schwartz, B. C. Lubin, M. R. Dicklin, A. C. Boileau and J. D. Bisognano, “The Hemodynamic Effects of Rebaudioside A in Healthy Adults with Normal and Low-Normal Blood Pressure,” Food and Chemical Toxicology, Vol. 46 No. 7, 2008, pp. S40-S46. doi:10.1016/j.fct.2008.04.040
[25] M. S. Melis, “Chronic Administration of Aqueous Extract of Stevia Rebaudiana in Rats: Renal Effects,” Journal of Ethnopharmacology, Vol. 47, No. 3, 1995, pp. 129-134. doi:10.1016/0378-8741(95)01271-Edoi:10.1089/thy.2007.0222

  
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