title: 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.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Kizuyabashi Takeda Hospital, Kyoto. kizuya@takedahp.or.jp
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Inada
authors.forename: Keiko
authors.initials: K
authors.lastname: Iwasaki
authors.forename: Chihiro
authors.initials: C
authors.lastname: Imai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hashimoto
mesh_terms: D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2 / Q000097:blood* / Q000652:urine; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003348:Cortisone / Q000097:blood* / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000652:urine; D006973:Hypertension / Q000097:blood* / Q000188:drug therapy / Q000652:urine; D008297:Male; D013148:Spironolactone / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D013148:Spironolactone; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2; D003348:Cortisone; D006854:Hydrocortisone