New studies of the 11 beta-hydroxylase and 18-hydroxylase enzymes in the hypertensive form of congenital adrenal hyperplasia.

Studies in four children with congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency provide evidence for two separate 11 beta-hydroxylating systems in the adrenal zona fasciculata and zona glomerulosa. In addition, these studies support the proposal that the adrenal 11 beta- and 18-hydroxylating activities are related and may involve the same enzyme protein and catalytic site. In the untreated or poorly treated state, despite elevation of deoxycorticosterone (DOC) and tetrahydrodeoxycorticosterone, urinary free 18-hydroxy-DOC was in the low normal range and did not increase normally with ACTH. PRA and urinary free 18-hydroxycorticosterone (18-OHB), tetrahydroaldosterone (TH Aldo), and pH 1 aldosterone were suppressed in the untreated and ACTH periods. Glucocorticoid administration suppressed plasma ACTH, and urinary tetrahydro-DOC and free DOC excretion decreased to the normal range. Concomitantly, there was a rise in PRA accompanied by parallel increase in urinary 18-OHB, urinary TH Aldo, and pH 1 aldosterone. While on dexamethasone, a low sodium diet (10 meq/day) resulted in prompt sodium retention, with a further rise in PRA and urinary 18-OHB, TH Aldo, and pH 1 aldosterone. These studies indicate the presence of both an 11 beta- and an 18-hydroxylase deficiency in the zona fasciculata and normal 11 beta- and 18-hydroxylase function in the zona glomerulosa, suggesting that these two enzymatic functions are related and that separate enzyme systems are present in the two zones.