Spironolactone Effective Hypertension in the Elderly Due to 11β-hydroxysteroid Dehydrogenase Type 2 (11β-HSD2) Impairment: Contributory Role of Determining Serum Cortisol/Cortisone Ratio as a Marker of 11β-HSD2 Activity

Two elderly patients with mineralocorticoid excess state due to 11 beta-hydroxysteroid dehydrogenase type 2 (11 beta-HSD2) impairment are described. Moreover, the role of the precursor-product ratios of the steroids reflecting 11 beta-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 11 beta-HSD2 impairment.