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©2013 UpToDate ® Print Email Synthetic pathways for adrenal steroid synthesis The first step in adrenal steroid synthesis is the combination of acetyl CoA and squalene to form cholesterol, which is then converted into pregnenolone. The enclosed area contains the core steroidogenic pathway utilized by the adrenal glands and gonads. 17α: 17α-hydroxylase (CYP17, P450c17); 17,20: 17,20 lyase (also mediated by CYP17); 3β: 3β-hydroxysteroid dehydrogenase; 21: 21-hydroxylase (CYP21A2, P450c21); 11β: 11β-hydroxylase; (CYP11B1, P450c11); 18 refers to the two-step process of aldosterone synthase (CYP11B2, P450c11as), resulting in the addition of an hydroxyl group that is then oxidized to an aldehyde group at the 18-carbon position; 17βR: 17β-reductase; 5αR: 5α-reductase; DHEA: dehydroepiandrosterone; DHEAS: DHEA sulfate; A: aromatase (CYP19); SK: sulfokinase; SL: sulfotransferase.