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Semin Vasc Med 2004; 4(2): 121-128
DOI: 10.1055/s-2004-835369
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Cortisol, 11β-Hydroxysteroid Dehydrogenases, and Hypertension

Stan H.M van Uum1 , Jacques W.M Lenders2 , Ad R.M.M Hermus3
  • 1Division of Endocrinology and Metabolism, Department of Medicine, University of Western Ontario, London, Ontario, Canada
  • 2Division of General Internal Medicine
  • 3Division of Endocrinology, Deptartment of Medicine, University Medical Center, Nijmegen, The Netherlands
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Publication History

Publication Date:
11 October 2004 (online)

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Hypersecretion of cortisol is associated with hypertension. In addition, an abnormal cortisol metabolism may play a role in the pathogenesis of hypertension. The 11β-hydroxysteroid dehydrogenase (11β-HSD) isozymes catalyze interconversion of cortisol and cortisone and play an important role in the regulation of the effects of cortisol. Activity of 11β-HSD type 2, converting active cortisol in inactive cortisone, is crucial in preventing access of cortisol to the renal mineralocorticoid receptors (MRs). Decreased activity of this isozyme in the kidney, either congenitally in Apparent Mineralocorticoid Excess syndrome or acquired following licorice consumption, allows cortisol access to the MRs, resulting in hypokalemic hypertension. In normotensive subjects, an association has been demonstrated between blood pressure increase on a high-salt diet and a mild decrease of renal 11β-HSD2 activity. In ectopic adrenocorticotropic hormone (ACTH), plasma cortisol levels are very high, resulting in mineralocorticoid hypertension caused by saturation of the available renal 11β-HSD2 capacity. Activity of the 11β-HSDs has also been demonstrated in many extrarenal sites. Several studies have demonstrated extrarenal effects of cortisol on blood pressure, as well as a possible role for altered extrarenal 11β-HSD activities in the pathogenesis of hypertension. More studies are needed to clarify the role of 11β-HSDs in the pathogenesis of hypertension.

KEYWORDS

Cortisol - 11β-hydroxysteroid dehydrogenases - hypertension - licorice

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Stan H.M van UumM.D. Ph.D.  Assistant Professor

Endocrinology and Metabolism, Department of Medicine, University of Western Ontario

St. Joseph's Health Centre, Room G401, 268 Grosvenor St.

London, Ontario N6A 4V2, Canada

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