Adrenal sex steroid hormones

Stikkelbroeck et al. (2001) investigated the prevalence of testicular tumors in 17 adolescent and adult male patients with CAH aged 16 to 40 years. In 16 of 17 patients, one or more testicular tumors ranging in maximal length from to cm were found on ultrasonography. In 6 patients, the testicular tumors were palpable. Undertreatment, defined as the presence of a salivary androstenedione level above the upper reference morning level, was found in 5 of 17 patients at the time of investigation. The other 12 patients were treated adequately or even overtreated at the time of investigation. Nevertheless, 11 of these 12 patients showed testicular tumors on ultrasonography. Tumor size was significantly larger in patients who were heterozygous or homozygous for deletion or conversion of the CYP21 gene than in patients who did not have this genotype. Impairment of Leydig cell function as manifested by decreased plasma levels of testosterone was found in 6 of 17 patients. Semen analysis in 11 patients revealed azoospermia in 3 patients and poor semen quality in 4 patients. The authors concluded that, when carefully sought for, testicular adrenal rest tumors are frequently present in adolescent and adult males with CAH and are often accompanied by impaired spermatogenesis and Leydig cell failure.

Patients with congenital adrenal hyperplasia usually have to take lifelong steroid medication. Current treatments try to mimic normal biology as much as possible, but are not perfect. The evidence suggests that if well treated during childhood, most patients with congenital adrenal hyperplasia will reach a normal adult height but probably be a little shorter than would have been predicted if they did not have the disorder. Fertility is reduced in some patients but there are an increasing number of options for helping patients achieve fertility. Reconstruction genital surgery might be required in older girls with ambiguous genitalia. Maintaining the right balance of steroids is important during adult life to avoid the complications of osteoporosis , obesity and hypertension. 

Cells of the zona fasciculata and zona reticularis lack aldosterone synthase (CYP11B2) that converts corticosterone to aldosterone, and thus these tissues produce only the weak mineralocorticoid corticosterone. However, both these zones do contain the CYP17A1 missing in zona glomerulosa and thus produce the major glucocorticoid, cortisol. Zona fasciculata and zona reticularis cells also contain CYP17A1, whose 17,20-lyase activity is responsible for producing the androgens, dehydroepiandrosterone (DHEA) and androstenedione. Thus, fasciculata and reticularis cells can make corticosteroids and the adrenal androgens, but not aldosterone.

When people have adrenal insufficiency they must be sure to pay special attention to times of increased stress on the body such as those undergoing surgery, those suffering from an illness or severe injury, and those who are pregnant. Even taking part in strenuous sports or exercise or working night shifts can affect cortisol levels. Some of these types of stress would require additional treatment to recover including “stress” dosages of corticosteroids, which may be given either intravenously or orally. When the person recovers from the stress situation, they can usually return to their usual amounts of medications.

As the body's key hormones fall below the minimum required reserve for normal function and output fails, the body may down-regulate the amount needed to preserve what is on hand for only the most essential body functions . This near-failure state (Phase D) is quite serious and requires professional attention. This is a state of extreme low energy as the body tries to conserve to survive. Normally helpful nutrients may backfire with paradoxical responses being the hallmark. Those in Phase D are usually bedridden most of the time. Normal daily chores need ambulatory help. Traditional macro-nutritional approaches may be helpful. But, the body may continue to decompensate. In these cases, a carefully titrated micro-nutritional program may be necessary to help the restore the body.

Adrenal sex steroid hormones

adrenal sex steroid hormones

When people have adrenal insufficiency they must be sure to pay special attention to times of increased stress on the body such as those undergoing surgery, those suffering from an illness or severe injury, and those who are pregnant. Even taking part in strenuous sports or exercise or working night shifts can affect cortisol levels. Some of these types of stress would require additional treatment to recover including “stress” dosages of corticosteroids, which may be given either intravenously or orally. When the person recovers from the stress situation, they can usually return to their usual amounts of medications.

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