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lüll Hypertension and the cortisol-cortisone shuttle Quinkler M; Stewart PMJ Clin Endocrinol Metab 2003[Jun]; 88 (6): 2384-9211 beta-Hydroxysteroid dehydrogenase type 2 (11 beta-HSD2) plays a crucial role in converting hormonally active cortisol to inactive cortisone, thereby conferring specificity on the mineralocorticoid receptor. Mutations in the gene encoding 11 beta-HSD2 (HSD11B2) account for an inherited form of hypertension, the syndrome of apparent mineralocorticoid excess, in which cortisol induces hypertension and hypokalemia. A similar clinical picture to apparent mineralocorticoid excess occurs after the ingestion of licorice and carbenoxolone, which are competitive inhibitors of 11 beta-HSD2. Reduced 11 beta-HSD2 activity may explain the increased sodium retention in preeclampsia, renal disease, and liver cirrhosis. Substrate saturation of 11 beta-HSD2 occurs in Cushing's syndrome and explains the mineralocorticoid excess state that characterizes ectopic ACTH syndrome. Polymorphic variability in the HSD11B2 gene in part determines salt sensitivity, a forerunner for adult onset hypertension. Furthermore, reduced placental 11 beta-HSD2 expression might underpin the Barker hypothesis, the epidemiological link between reduced birth weight and adult hypertension. At a prereceptor level, 11 beta-HSD2 plays a key role in normal physiology in the corticosteroid regulation of sodium homeostasis and pathophysiology of hypertension.|11-beta-Hydroxysteroid Dehydrogenase Type 2[MESH]|Cortisone/*biosynthesis[MESH]|Humans[MESH]|Hydrocortisone/*metabolism[MESH]|Hydroxysteroid Dehydrogenases/*metabolism[MESH]|Hypertension/etiology/*metabolism[MESH]|Mineralocorticoids/metabolism[MESH] |