Non-traditional metabolic pathways of adrenal steroids.

Metabolic pathways are reconstructed from biochemical evidence to conceptualize the predominant route to important biomolecules. Pathways have heuristic value in their capacity to explain the metabolic derangements in genetic diseases of enzyme deficiencies and during pharmacologic inhibition of these enzymes. Implicit in the description of these pathways is the potential existence of alternate routes, variable order of reactions, and the inevitable by-products generated by incomplete efficiencies and competing enzymes. This chapter will consider alternate fates encountered by steroid hormone precursors in the adrenal gland, the variables influencing flux through these secondary pathways, and the significance of these diversions in health and disease.