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Late-onset apparent mineralocorticoid excess caused by novel compound heterozygous mutations in the HSD11B2 gene

Lookup NU author(s): Professor Chris Edwards


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Mutations in the gene encoding 11β-hydroxysteroid dehydrogenase type 2, 11β-HSD2 (HSD11B2), explain the molecular basis for the syndrome of apparent mineralocorticoid excess (AME), characterized by severe hypertension and hypokalemic alkalosis. Cortisol is the offending mineralocorticoid in AME, as the result of a lack of 11β-HSD2-mediated cortisol to cortisone inactivation. In this study, we describe mutations in the HSD11B2 gene in 3 additional AME kindreds in which probands presented in adult life, with milder phenotypes including the original seminal case reported by Stewart and Edwards. Genetic analysis of the HSD11B2 gene revealed that all probands were compound heterozygotes, for a total of 7 novel coding and noncoding mutations. Of the 7 mutations detected, 6 were investigated for their effects on gene expression and enzyme activity by the use of mutant cDNA and minigene constructs transfected into HEK 293 cells. Four missense mutations resulted in enzymes with varying degrees of activity, all < 10% of wild type. A further 2 mutations generated incorrectly spliced mRNA and predicted severely truncated, inactive enzyme. The mothers of 2 probands heterozygous for missense mutations have presented with a phenotype indistinguishable from "essential" hypertension. These genetic and biochemical data emphasize the heterogeneous nature of AME and the effects that heterozygosity at the HSD11B2 locus can have on blood pressure in later life.

Publication metadata

Author(s): Lavery GG, Ronconi V, Draper N, Rabbitt EH, Lyons V, Chapman KE, Walker EA, McTernan CL, Giacchetti G, Mantero F, Seckl JR, Edwards CRW, Connell JMC, Hewison M, Stewart PM

Publication type: Article

Publication status: Published

Journal: Hypertension

Year: 2003

Volume: 42

Issue: 2

Pages: 123-129

ISSN (print): 0194-911X

ISSN (electronic): 1524-4563

Publisher: Lippincott Williams & Wilkins


DOI: 10.1161/01.HYP.0000083340.57063.35

PubMed id: 12860834


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