There are currently two, distantly related members of the short-chain alcohol dehydrogenase family with 11\g=b\-hydroxysteroiddehydrogenase activity that have been cloned, expressed and characterized. The first of these (1) is now termed 11\g=b\-hydroxysteroiddehydrogenase type 1 (11-HSD1), and catalyses the interconversion of cortisol and corticosterone to/from their receptor-inactive 11-keto analogues cortisone and 11dehydrocorticosterone, with NADP/NADPH as preferred co-substrate. 11\g=b\-Hydroxysteroiddehydrogenase type 1 is found at high abundance in liver, testis, lung and renal proximal tubule; its Km for cortisone and 11-dehydrocorticosterone is an order of magnitude lower than for cortisol and corticosterone, but is commonly in the micromolar range. The combination of low affinity, predominant reductase activity and tissue distribution makes 11-HSD1 an unlikely candidate protector of epithelial mineralocorticoid receptors, which have similar high affinity for aldosterone, cortisol and corticosterone. In addition, no 11-HSD1 sequence abnormalities were detected on analysis of five patients (2) with the syndrome of Apparent Mineralocorticoid Excess (AME), long suspected to reflect congenitally lowered 11-HSD activity, allowing glucocorticoids to access and activate epithelial mineralocorticoid receptors.The second human isoform has been cloned and expressed more recently (3), and has much higher (35% vs 15%) amino acid identify with 17-HSD2 than 11-HSD1. Human 11-HSD2 has a much lower Km for physiological glucocorticoids than 11-HSD1 (cortico¬ sterone,~5 nmol/1; cortisol,~50nmol/1), is NAD dependent and apparently unidirectional. As noted in the study of Diederich et al. (4), the subsequent cloning of 11-HSD2 in laboratory animals has allowed its localization to be documented extensively. In all species studied, high levels of 11-HSD2 expression are seen in classical aldosterone target tissues (kidney, colon, parotid); moderate/high levels are also seen in adrenal, pancreas and placenta in some but not all species, which is evidence of possible roles for 11-HSD2 over and above that of excluding physiological glucocorticoids from epithelial mineralocorticoid receptors. That this latter role is, however, crucial has been shown by very recent studies in which mutations in the gene coding for 11-HSD2 have been reported for patients with AME (5-7). More than a dozen kindred have been analysed, and have shown a wide variety of point mutations/deletions that lower or abolish enzyme activity, allowing circulating glucocorticoids access to epithelial mineralocorticoid receptors and thus controlled salt retention. To date, all affected (homozygous) patients have different mutations/ deletions, with the exception of a Zoroastrian Melbourne family of Iranian extraction and two Parsee families from Bombay. Secondly, all affected patients documented to date have the same mutation in both DNA strands, even where consanguinity/endogamy do not appear to be in evidence. Given that 11-HSD2 is thus clearly required for normal...