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Adrenocortical hormone excess, due to primary aldosteronism (PA) or hypercortisolemia, causes hypertension and cardiovascular complications. In PA, hypomethylation of aldosterone synthase ( CYP11B2 ) is associated with aldosterone overproduction. However, in hypercortisolemia, the role of DNA methylation of 11β-hydroxylase ( CYP11B1 ), which catalyzes cortisol biosynthesis and is highly homologous to  CYP11B2 , is unclear. The aims of our study were to determine whether the  CYP11B1  expression was regulated through DNA methylation in hypercortisolemia with cortisol-producing adenoma (CPA), and to investigate a possible relationship between DNA methylation and somatic mutations identified in CPA. Methylation analysis showed that the  CYP11B1  promoter was significantly less methylated in CPA than in adjacent unaffected adrenal tissue and white blood cells. Furthermore, in CPA with somatic mutations in either the catalytic subunit of protein kinase A ( PRKACA ) or the guanine nucleotide-binding protein subunit alpha ( GNAS ) gene, the  CYP11B1  promoter was significantly hypomethylated. In addition, DNA methylation reduced  CYP11B1  promoter activity using a reporter assay. Our study results suggest that DNA methylation at the  CYP11B1  promoter plays a role in the regulation of  CYP11B1  expression and cortisol production in CPA, and that somatic mutations associated with CPA reduce DNA methylation at the  CYP11B1  promoter.

Cortisol overproduction results from DNA methylation of CYP11B1 in hypercortisolemia