It has been found that a potential exogenous steroid precursor such as cholesterol is not utilized by inhomogeneous rat adrenal cell suspensions, even under stimulation by ACTH or cAMP, unless exogenous NADPH or NADPH generation is provided. Furthermore, it has been shown that cAMP does not interfere with NADPH generation but stimulates NADPH utilization. A scheme is proposed for steroidogenesis in isolated rat adrenocortical cells considering precursor utilization and the various effects exerted by cAMP, NADPH and cycloheximide, respectively.
For women with idiopathic hirsutism, PCOS, or late-onset CAH, appropriate treatment decisions depend on each patient's desires and childbearing plans. Women who do not wish to become pregnant should use low-dose OCs. OCs containing less androgenic progestins, such as norgestimate, gestodene (not available in the United States), and desogestrel, seem to be the best choice, but some maintain that all preparations are comparable in efficacy. 24 These agents increase the level of SHBG and therefore decrease ovarian androgen production while decreasing the risk of endometrial hyperplasia often seen in anovulatory women. 25 , 26
Catecholamines are produced in chromaffin cells in the medulla of the adrenal gland, from tyrosine , a non-essential amino acid derived from food or produced from phenylalanine in the liver. The enzyme tyrosine hydroxylase converts tyrosine to L-DOPA in the first step of catecholamine synthesis. L-DOPA is then converted to dopamine before it can be turned into noradrenaline. In the cytosol , noradrenaline is converted to epinephrine by the enzyme phenylethanolamine N-methyltransferase (PNMT) and stored in granules. Glucocorticoids produced in the adrenal cortex stimulate the synthesis of catecholamines by increasing the levels of tyrosine hydroxylase and PNMT.