{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:25:52Z","timestamp":1791429952582,"version":"4.3.3"},"reference-count":94,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:p>Since the early 1980s 18-hydroxycortisol and 18-oxocortisol have attracted attention when it was shown that the urinary excretion of these hybrid steroids was increased in primary aldosteronism. The development and more widespread use of specific assays has improved the understanding of their role in the (patho)physiology of adrenal disorders. The adrenal site of synthesis is not fully understood although it is clear that for the synthesis of 18-hydroxycortisol and 18-oxocortisol the action of both aldosterone synthase (zona glomerulosa) and 17\u03b1-hydroxylase (zona fasciculata) is required with cortisol as main substrate. The major physiological regulator is ACTH and the biological activity of both steroids is very low and therefore only very high concentrations might be effective<jats:italic>in vivo<\/jats:italic>. In healthy subjects, the secretion of both steroids is low with 18-hydroxycortisol being substantially higher than that of 18-oxocortisol. The highest secretion of both steroids has been found in familial hyperaldosteronism type 1 (glucocorticoid-remediable aldosteronism) and in familial hyperaldosteronism type 3. Lower but yet substantially increased secretion is found in patients with aldosterone-producing adenomas in contrast to bilateral hyperplasia in whom the levels are similar to patients with hypertension. Several studies have attempted to show that these steroids, in particular, peripheral venous plasma 18-oxocortisol, might be a useful discriminatory biomarker for subtyping PA patients. The current available limited evidence precludes the use of these steroids for subtyping. We review the biosynthesis, regulation and function of 18-hydroxycortisol and 18-oxocortisol and their potential utility for the diagnosis and differential diagnosis of patients with primary aldosteronism.<\/jats:p>","DOI":"10.1530\/eje-17-0563","type":"journal-article","created":{"date-parts":[[2017,9,14]],"date-time":"2017-09-14T00:55:53Z","timestamp":1505350553000},"page":"R1-R9","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":54,"title":["DIAGNOSIS OF ENDOCRINE DISEASE: 18-Oxocortisol and 18-hydroxycortisol: is there clinical utility of these steroids?"],"prefix":"10.1093","volume":"178","author":[{"given":"Jacques W M","family":"Lenders","sequence":"first","affiliation":[{"name":"1Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"2Department of Internal Medicine III, Technische Universit\u00e4t Dresden, Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy Ann","family":"Williams","sequence":"additional","affiliation":[{"name":"3Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy"},{"name":"4Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Reincke","sequence":"additional","affiliation":[{"name":"4Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celso E","family":"Gomez-Sanchez","sequence":"additional","affiliation":[{"name":"5Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and the University of Mississippi Medical Center, Jackson, Mississippi, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"ref581","first-page":"295","article-title":"Role of multidrug resistance glycoprotein in the secretion of aldosterone by human adrenal cells of","author":"Bello","journal-title":"American Journal Physiology Cell Physiology"},{"key":"ref671","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1210\/jcem-67-2-322","article-title":"Effect of chronic adrenocorticotropin stimulation on the excretion of 18-hydroxycortisol and 18-oxocortisol","volume":"67","year":"1988","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref161","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/0022-4731(87)91064-8","article-title":"Blood pressure and metabolic effects of 18-oxo-cortisol in sheep","volume":"28","year":"1987","journal-title":"Journal of Steroid 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