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Glucocorticoid-suppressible hyperaldosteronism (GSH), first described in 1966 (Sutherland et al. 1966), is a rare cause of familial hypertension. It presents in young adults with hypertension, hypokalaemia and suppressed plasma renin activity (features caused by the excess activity of aldosterone secretion), and is distinguished from other forms of primary hyperaldosteronism by its autosomal dominant mode of inheritance and the reversal of all its clinical and biochemical abnormalities by the administration of small doses of the synthetic glucocorticoid dexamethasone (Connell et al. 1986). GSH is also characterized by abnormally elevated levels of 18-hydroxycortisol and 18-oxocortisol, the excretion of which also falls to normal following dexamethasone administration (Chu & Ulick, 1982; Ulick et al. 1983; Gomez-Sanchez et al. 1984). The study of the production of these unusual 18-hydroxylated steroids has led to a reappraisal of the late reactions in aldosterone and cortisol synthesis by the adrenal cortex,