Clinical case seminar: Type 1 aldosterone synthase deficiency presenting in a middle-aged man

Kathleen M. Kayes-Wandover, R. E. Lee Schindler, Harris C. Taylor, Perrin C. White

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Aldosterone synthase deficiency due to mutations in the CYP11B2 gene usually presents in infancy with electrolyte abnormalities and failure to thrive, whereas affected adults are usually asymptomatic. We describe a patient who first came to medical attention in middle age when he developed hyperkalemia after preparation for a barium enema. Past medical history was notable for failure to thrive in infancy. He had elevated PRA with low serum and urinary levels of aldosterone and its metabolites and normal or slightly elevated levels of 18-hydroxycorticosterone. These findings suggested a diagnosis of type 1 aldosterone synthase deficiency. The patient had a homozygous duplication of six nucleotides at codon 143 in exon 3 of CYP11B2, leading to the insertion of two amino acid residues (Arg-Leu). When the corresponding mutant complementary DNA was expressed in cultured cells, the resulting enzyme was completely inactive, confirming the diagnosis. We conclude that aldosterone synthase deficiency represents an unusual cause of hyperreninemic hypoaldosteronism presenting in adult life, but it should be suspected if the past medical history is positive for failure to thrive in childhood or if the patient manifests no other recognized causes of hyperreninemic hypoaldosteronism.

Original languageEnglish (US)
Pages (from-to)1008-1012
Number of pages5
JournalJournal of Clinical Endocrinology and Metabolism
Issue number3
StatePublished - Apr 30 2001

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


Dive into the research topics of 'Clinical case seminar: Type 1 aldosterone synthase deficiency presenting in a middle-aged man'. Together they form a unique fingerprint.

Cite this