Fig. 7.12 The pathways and the enzymes involved in the synthesis of glucocortlcoids, mineralocorticoids, and adrenal androgens from a cholesterol precursor. Deficiency of any of the enzymes may occur, leading to different forms of congenital adrenal hyperplasia. Deficiency of 21-hydroxylase is the most common, resulting in vinlisation, in utero or later, with variable degrees of adrenal insufficiency.