甘草誘発性偽性アルドステロン症の1例

Abstract

76歳男.主訴は排尿困難.高血圧, 下肢浮腫, 低カリウム血症, 代謝性アルカローシスからアルドステロン症を疑い腹部CT施行するも, 両側とも副腎の腫大は認めなかった.この時点で他院での処方薬を調べると, 芍薬甘草薬が処方されており, この服薬を中止した.これより高血圧は徐々に改善され, 下肢浮腫も認めなくなった.血漿カリウム値も改善され, カリウム製剤は中止した.また, 同日測定した血中アルドステロン, レニン活性はいずれも低値を示していた.以上の経過から甘草誘発性偽性アルドステロン症と診断し, VCUGを施行した.その後の検査では, 血漿カリウム値, 血中アルドステロン, レニン活性はいずれも正常値に回復していた

We report a case of pseudoaldosteronism induced by licorice in a kampo medication 'Shakuyaku Kanzou Tou' that was diagnosed after relief of urinary retention due to benign prostatic hypertrophy (BPH). A-71-year-old man was admitted to our hospital due to urinary retention. At admission, he had hypertension and leg edema, but serum potassium was in the normal range. One day after admission, hypokalemia was recognized. He was taking "Shakuyaku Kanzou Tou", a Chinese medicine that contains glycyrrhizin. So we suspected pseudoaldosteronism and had him stop taking it. Computed tomography did not reveal any adrenal tumor. Plasma rennin activity and aldosterone level were suppressed. Gradually, hypertension and leg edema improved and serum potassium became within the normal range. We diagnosed the case as pseudoaldosteronism induced by licorice of 'Shakuyaku Kanzou Tou'. Since we suspected BPH to be the cause of urinary retention, we performed transurethral resection of prostate. After surgery, he was able to void smoothly.