Abstract
A syndrome of hypertension and hypokalemic alkalosis with low PRA and low aldosterone levels was found in users of an Italian proprietary steroid-containing nasal spray. There was complete remission of these abnormalities when use of the spray was discontinued. The steroidal component of the spray was thought to be 6α-fluoroprednisolone, but when the steroid hormone receptor affinity of a reference sample was evaluated, its properties, which were found to be predominantly glucocorticoid, did not explain the observed biological effects. Isolation of the active steroidal component in the spray was therefore undertaken. Chromatographic properties and mass spectrometry established its identity as 9α-fluoroprednisolone (llβ,17α,21-trihydroxy-9α-fluoro-l,4- pregnadiene-3,20-dione). This steroid was found to be as potent a mineralocorticoid as aldosterone in terms of its affinity for the kidney cytoplasmic mineralocorticoid receptor and its effect on the urinary Na to K ratio in the adrenalectomized rat. Patient...
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