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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.

has been cited by the following article:

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

  AUTHORS: Salina Esmail, Udaya M. Kabadi

  KEYWORDS: Edema; Enigma; 11 B-Hydroxysteroid Dehydrogenase Type 2; Sweetener “Stevia”

  JOURNAL NAME: Open Journal of Endocrine and Metabolic Diseases, Vol.2 No.3, August 2, 2012

  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.