An alternative explanation of hypertension associated with 17 alpha-hydroxylase deficiency syndrome

The syndrome of 17 alpha-hydroxylase deficiency is due to the inability to synthesize cortisol and is associated with enhanced secretion of both corticosterone and 11-deoxy-corticosterone (DOC). In humans, corticosterone and its 5 alpha-Ring A-reduced metabolites are excreted via the bile into the intestine and transformed by anaerobic bacteria to 21-dehydroxylated products: 11 beta-OH-progesterone or 11 beta-OH(allo)-5 alpha-preganolones (potent inhibitors of 11 beta-HSD2 and 11 beta-HSD1 dehydrogenase). Neomycin blocks the formation of these steroid metabolites and can blunt the hypertension in rats induced by either ACTH or corticosterone. 3 alpha,5 alpha-Tetrahydro-corticosterone, 11 beta-hydroxy-progesterone, and 3 alpha,5 alpha-tetrahydro-11 beta-hydroxy-progesterone strongly inhibit 11 beta-HSD2 and 11 beta-HSD1 dehydrogenase activity; all these compounds are hypertensinogenic when infused in adrenally intact rats. Urine obtained from a patient with 17 alpha-hydroxylase deficiency demonstrated markedly elevated levels of endogenous glycyrrhetinic acid-like factors (GALFs) that inhibit 11 beta-HSD2 and 11 beta-HSD1 dehydrogenase activity (>300 times greater, and >400 times greater, respectively, than those in normotensive controls). Thus, in addition to DOC, corticosterone and its 5 alpha-pathway products as well as the 11-oxygenated progesterone derivatives may play a previously unrecognized role in the increased Na+ retention and BP associated with patients with 17 alpha-hydroxylase deficiency. (C) 2013 Published by Elsevier Inc.