Whorwood CB, Gupta A, Krozowski Z, Stewart PM
Human hypertension caused by a single point mutation in the type 2 11-beta-hydroxysteroid dehydrogenase (h11 b-HSD2) gene
16th Scientific Meeting of the International Society of Hypertension
ISH Abstract Book (Jun) 16: 1996

Severe low renin/low aldosterone hypertension with hypokalemia can arise from congenital deficiency of h11 b-HSD (referred to as the Syndrome of Apparent Mineralocorticoid Excess (AME)), where the resulting impaired conversion of cortisol (F) to hormonally inactive cortisone (E) allows F to preferentially occupy the mineralocorticoid receptor. Two kinetically distinct isoforms of h11 b-HSD have now been characterized and cloned. The h11 b-HSD1 gene is, however, normal in AME patients.

This study reports the sequence and the expression analysis of the h11 b-HSD2 gene in an Asian kindred with AME. The study revealed a consistent single C r T mutation at nt1228 of the cDNA, which converts Arg (CGA) to a premature stop (TGA) at codon 374 in exon 5. No mutations were evident elsewhere in the gene. The resulting truncated h11 b-HSD2 protein lacks the proline-rich C-terminal 32 amino acids. Hypertension in this kindred was caused by a premature-stop codon in exon 5 of the h11 b-HSD2 gene.

Comment: This establishes AME alongside glucocorticoid-suppressible hyperaldosteronism & Liddle's syndrome as examples of monogenic causes of hypertension (Carmine Zoccali, M.D, Reggio Calabria, Italy).

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16th Scientific Meeting of the International Society of Hypertension
H: Pathophysiology : Genetics
H: Special problems : Endocrine hypertension