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. Author manuscript; available in PMC: 2016 Dec 1.
Published in final edited form as: Eur J Endocrinol. 2015 Sep 4;173(6):727–737. doi: 10.1530/EJE-15-0064

Figure 1. Pathway of adrenal steroidogenesis.

Figure 1

Normally, the principal route for adrenocortical androgen production is via the classic pathway (solid line arrows). In 21-hydroxylase deficiency, large amounts of 17OHP are converted to androstenedione via this classic pathway and these are the common biomarkers used in CAH to estimate disease control. Accumulating 17OHP can also be converted to pdione via an alternative route termed the backdoor pathway (dotted arrows). Androsterone is produced by both the classic and backdoor pathways. The end product for both pathways is ultimately dihydrotestosterone (DHT), the most potent androgen receptor agonist.