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(Hypertension. 2001;38:688.)
© 2001 American Heart Association, Inc.

Endocrine Systems

Serum 18-Hydroxycortisol in Primary Aldosteronism, Hypertension, and Normotensives

Lorena Mosso; Celso E. Gómez-Sánchez; Mark F. Foecking; Carlos Fardella

Department of Endocrinology Faculty of Medicine Pontificia Universidad Católica de Chile (L.M., C.F.), Santiago, Chile; Division of Endocrinology, The University of Mississippi Medical Center and the G.V. (Sonny) Montgomery VA Medical Center (C.E.G.-S.), Jackson, Miss; and Harry S. Truman VA Medical Center (M.F.F.), Columbia, Mo.

Correspondence to Lorena Mosso Gómez, Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Lira 44 2° piso, Santiago, Chile. E-mail mosso{at}med.puc.cl

Abstract

Abstract—— This study reports the determination of plasma 18-hydroxycortisol (18-OHF) using a new and easy enzyme-linked immunosorbent assay (ELISA) method in primary aldosteronism and compares the values found in essential hypertensives and normotensive controls. In primary aldosteronism, we evaluated usefulness of plasma 18-OHF determination and the dexamethasone suppression test in the diagnosis of glucocorticoid-remediable aldosteronism using the genetic test as the gold standard. We studied 31 primary aldosteronism patients, 101 essential hypertensives, and 102 healthy normotensive controls. The plasma 18-OHF was measured using a biotin-avidin enzyme-linked assay by a new and purified polyclonal antibody. The 18-OHF value in primary aldosteronism was 6.3±8.05 nmol/L; this value is significantly higher than the value found in essential hypertensives and normotensive controls (2.81±1.42 and 2.70±1.41 nmol/L, respectively; P<0.0005). In primary aldosteronism, 4 of 31 patients had 18-OHF levels that were 10 times higher than the normal upper limit (2.983 nmol/L). The dexamethasone suppression test in primary aldosteronism patients was positive (serum aldosterone <4 ng/dL) in 13 of 31 cases. A chimeric CYP11B1/CYP11B2 gene was demonstrated in 4 primary aldosteronism patients, corresponding to the same cases that had higher level of 18-OHF. In conclusion, plasma 18-OHF determination by this ELISA method is reliable for detecting glucocorticoid-remediable aldosteronism, and it does so better than the dexamethasone suppression test.

Key Words: 18-hydroxycortisol • hypertension, mineralocorticoid • glucocorticoids • aldosterone

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