Review of Adrenal Androgen Synthesis, Hypersecretion, and Blockade

Production of adrenal androgens begins with cholesterol, and through a series of enzymatic steps catalyzed by the cytochrome p450 superfamily, forms several 19-carbon sex hormones. Benign disorders of adrenal androgen hypersecretion include adrenal variants of polycystic ovarian syndrome, congenital adrenal hyperplasia, and nonmalignant tumors. Adrenocortical carcinomas can also oversecrete adrenal androgens. Primary adrenal hypoandrogenism is not generally accepted as a stand-alone diagnosis in women. Blockade of adrenal androgens has emerged as contemporary treatment of men with metastatic prostate cancer. Here, we explore the history of the adrenal gland, its biosynthetic pathway, and common disorders of adrenal androgen hypersecretion and blockade.