TY - JOUR
T1 - Apparent cortisone reductase deficiency
T2 - A functional defect in 11β-hydroxysteroid dehydrogenase type 1
AU - Jamieson, A.
AU - Wallace, A. M.
AU - Andrew, R.
AU - Nunez, B. S.
AU - Walker, B. R.
AU - Fraser, Robert
AU - White, P. C.
AU - Connell, J. M C
PY - 1999
Y1 - 1999
N2 - A 36-yr-old woman was referred to the endocrine clinic for investigation of oligomenorrhea, hirsutism, and acne. She was plethoric and overweight with central fat distribution. Plasma cortisol was normal, but her adrenal glands were enlarged (CT scan). Urinary tetrahydrocortisone excretion rate was consistently high, raising the possibility of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) deficiency. In addition, 5β- reduction of cortisol and cortisone was markedly enhanced. The levels of all cortisol metabolites were suppressed normally with dexamethasone, but conversion of oral cortisone acetate to plasma cortisol was delayed and subnormal compared with that of healthy volunteers. This was accompanied by a larger than normal increase in plasma cortisone concentration. Thus, the defect appears to be in 11β-HSD1 activity and not in 5β-reductase activity. Three close relatives of the subject showed no comparable abnormalities, and analysis of the coding region and exon/intron boundaries of the 11β-HSD1 gene of the case revealed no differences from the consensus sequence. The defect may lie outside the coding region. Alternatively, some other inherited or acquired defect may lead to inhibition of this enzyme system.
AB - A 36-yr-old woman was referred to the endocrine clinic for investigation of oligomenorrhea, hirsutism, and acne. She was plethoric and overweight with central fat distribution. Plasma cortisol was normal, but her adrenal glands were enlarged (CT scan). Urinary tetrahydrocortisone excretion rate was consistently high, raising the possibility of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) deficiency. In addition, 5β- reduction of cortisol and cortisone was markedly enhanced. The levels of all cortisol metabolites were suppressed normally with dexamethasone, but conversion of oral cortisone acetate to plasma cortisol was delayed and subnormal compared with that of healthy volunteers. This was accompanied by a larger than normal increase in plasma cortisone concentration. Thus, the defect appears to be in 11β-HSD1 activity and not in 5β-reductase activity. Three close relatives of the subject showed no comparable abnormalities, and analysis of the coding region and exon/intron boundaries of the 11β-HSD1 gene of the case revealed no differences from the consensus sequence. The defect may lie outside the coding region. Alternatively, some other inherited or acquired defect may lead to inhibition of this enzyme system.
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U2 - 10.1210/jcem.84.10.6031
DO - 10.1210/jcem.84.10.6031
M3 - Article
C2 - 10522997
AN - SCOPUS:0033304914
SN - 0021-972X
VL - 84
SP - 3570
EP - 3574
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 10
ER -