Alteration of the Activity of the 11β-Hydroxysteroid Dehydrogenase in Pregnancy: Relevance for the Development of Pregnancy-Induced Hypertension?

In this study we evaluated the activity of renal 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) in patients with pregnancy-induced hypertension (PIH). A reduction of the activity of 11β-HSD2 leads to pseudohyperaldosteronism due to insufficient interconversion of cortisol to its inactive 11-oxo-metabolite cortisone in the renal tubulus cell. We measured urinary free cortisol and cortisone in patients with and without PIH and calculated the urinary free cortisol to free cortisone ratio, which is well accepted as a correlate of the activity of renal 11β-HSD2. One hundred twenty-six pregnant women were included. Fifty-nine patients had PIH (mean age 31.5 ± 4.4 yr, blood pressure 158.7 ± 16.0/100.8 ± 9.5 mm Hg), and 67 were normotensive (mean age 29.4 ± 4.6, blood pressure 112.6 ± 8.9/68.8 ± 8.6 mm Hg). The excretion rate of cortisol was increased in the PIH group (138.8 ± 93.0 vs. 106.5 ± 65.4 nmol/d, P = 0.027), whereas excretion rate of cortisone was similar (362.9 ± 254.1 vs. 366.5 ± 221.7 nmol/d, P =...