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Of note, ACTH induces steroidogenesis in all 3 zones by stimulating this rate-limiting enzyme. CYP11A1 catalyzes the rate-limiting step of steroid hormone production, and it is expressed in all three layers of the adrenal cortex.

In the inner mitochondrial membrane, the cholesterol can then be converted to pregnenolone via CYP11A1 (cholesterol desmolase, or cholesterol side-chain cleavage, P450scc).

Once cholesterol enters the cell, steroidogenic acute regulatory protein (StAR) regulates cholesterol transport from the outer mitochondrial membrane to the inner mitochondrial membrane. The zona glomerulosa produces mineralocorticoids, the zona fasciculata produces glucocorticoids, and the zona reticularis produces androgen precursors (mostly DHEA with some androstenedione). However, the specific steroid hormone produced differs in each layer because of zonal specific enzymes. Each layer produces steroid hormones from the precursor cholesterol. It has 3 distinct functional and histological zones: the zona glomerulosa (outermost layer), the zona fasciculata (middle layer), and the zona reticularis (innermost layer). In females, an imbalance may result in amenorrhea, hirsutism, or infertility, and males can have early puberty or infertility.The adrenal cortex takes part in steroidogenesis, producing glucocorticoids, mineralocorticoids, and androgen precursors. A DHEAS blood test is done to help diagnose adrenal tumors, cancer, or sex hormone imbalances that may be affecting a person's development. Dehydroepiandrosterone sulfate (DHEAS) test: DHEAS can be converted into sex hormones like estrogen and testosterone.Cortisol can also be measured with a 24-hour urine test (where you collect a day’s worth of urine and send it to a laboratory for analysis) or through saliva as a swab test (in certain instances). A blood draw is done twice during the day, once in the morning and another later in the day.

Cortisol test: This test is used to look for signs of Cushing’s syndrome or Addison’s disease (when the adrenal glands make too much and too little cortisol, respectively).

Benign adrenal gland tumors are very common, while adrenal cancer is rare, affecting 1 or 3 per 1 million people.

An aldosterone test can diagnose adrenal fatigue or insufficiency, or a possible tumor in the adrenal glands.

Aldosterone test: With a sample of blood or urine, this test monitors how much aldosterone is in the body.

A heel prick blood sample is analyzed for 17-hydroxyprogesterone, which is created when cortisol is produced by the adrenal glands.

17-Hydroxyprogesterone (or 17-OHP) test: This test is usually done as part of newborn screening in order to detect congenital adrenal hyperplasia.