Spironolactone effective hypertension in the elderly due to 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) impairment: contributory role of determining serum cortisol/cortisone ratio as a marker of 11beta-HSD2 activity

• Published in: Internal medicine (Tokyo, 1992) Vol. 47; no. 24; pp. 2157 - 2164
• Main Authors: Inada, Mitsuo, Iwasaki, Keiko, Imai, Chihiro, Hashimoto, Satoshi
• Format: Journal Article
• Language: English
• Published: Japan 2008
• Subjects: 11-beta-Hydroxysteroid Dehydrogenase Type 2 - blood; 11-beta-Hydroxysteroid Dehydrogenase Type 2 - urine; Aged; Biomarkers - blood; Biomarkers - urine; Cortisone - blood; Cortisone - urine; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - urine; Female; Humans; Hydrocortisone - blood; Hydrocortisone - urine; Hypertension - blood; Hypertension - drug therapy; Hypertension - urine; Male; Spironolactone - therapeutic use
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.47.1165

Two elderly patients with mineralocorticoid excess state due to 11 beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) impairment are described. Moreover, the role of the precursor-product ratios of the steroids reflecting 11beta-HSD2 activity was estimated in 5 patients, including 3 patients reported previously by us. Significant elevations of urinary cortisol/cortisone ratios were observed, whereas urinary tetrahydrocortisol (THF)+allo-THF/tetrahydrocortisone (THE) ratios were not elevated significantly. Furthermore, an even more distinct elevation of serum cortisol/cortisone ratio was evident in all instances of 5 patients, suggesting a significant clinical role of the serum cortisol/cortisone ratio in the diagnosis of 11beta-HSD2 impairment.