CORTISOL METABOLISM IN HYPERTENSIVE PATIENTS WHO DO AND DO NOT DEVELOP HYPOKALEMIA FROM DIURETICS

Deficiency of 11 beta-hydroxysteroid dehydrogenase causes hypertension and hypokalemia. To test whether hypertensive patients who develop hy pokalemia when treated with diuretics have low levels of activity of t his enzyme as a metabolic predisposition to the development of hypokal emia, we measured urinary cortisone, cortisol, tetrahydrocortisol, tet rahydrocortisone, and creatinine in 42 hypertensive patients who eithe r did or did not become hypokalemic on hydrochlorothiazide. The mean r atios of cortisone to cortisol, tetrahydrocortisone to tetrahydrocorti sol, tetrahydrocortisol to cortisol, and cortisol to creatinine did no t differ between the two groups. We conclude that hypertensives who de velop hypokalemia on diuretics do not have low activity of this enzyme . They also do not appear to have low ring A reduction or higher corti sol secretion rates compared with hypertensives who do not develop hyp okalemia. We failed to find a metabolic predisposition to the developm ent of hypokalemia by diuretic treatment.