Androgen Synthesis Chart

An enzyme defect in the adrenal or ovarian steroidogenic pathways can also cause androgen excess. Congenital adrenal hyperplasia (CAH) due to an
autosomal recessive disorder is the most common cause of an enzyme defect. In 90% of cases, the enzyme 21-hydroxylase is missing or defective,
whereas in a minority of cases, the 11a-hydroxylase enzyme or the 3a-hydroxy-steroid dehydrogenase enzyme is missing or defective. When these
enzymes are missing or functioning at low levels, the body cannot make adequate amounts of the adrenal steroid hormones cortisol and aldosterone. In
turn, the low levels of circulating adrenal steroid hormones result in high levels of ACTH, which stimulate adrenal hyperplasia and hypersecretion of
androgen precursors for cortisol and aldosterone synthesis.