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Retired NBME 27 Answers

nbme27/Block 2/Question#49 (reveal difficulty score)
A 34-year-old woman comes to the office ...
11รŸ-Hydroxysteroid dehydrogenase type II ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(19)
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Syndrome of Apparent Mineralocorticoid Excess

Autosomal recessive disorder

Can also acquire the disorder from ingestion of glycyrrhetinic acid (present in licorice), which blocks the activity of 11รŸ-HSD. Glycrrhetinic acid, or enoxolone, is the active ingredient in licorice and primarily inhibits 11รŸ-HSD, which is responsible for the conversion of cortisol to cortisone. With increased concentrations of cortisol (and decreased concentrations of cortisone), downstream mineralocorticoid effects are observed, which cause inhibition of the RAAS pathway and decreased serum concentrations of its associated hormones.

Mineralocorticoid receptor activity causes metabolic alkalosis, hypokalemia, hypertension, and decreased serum aldosterone.

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