Age-specific changes in sex steroid biosynthesis and sex development

Nils Krone, NA Hanley, Wiebke Arlt

    Research output: Contribution to journalArticle

    26 Citations (Scopus)


    Normal male sex development requires the SRY gene on the Y chromosome, the regression of Müllerian structures via anti-Müllerian hormone (AMH) signalling, the development of the Wolffian duct system into normal male internal genital structures consequent to testosterone secretion by the testicular Leydig cells, and finally, sufficient activation of testosterone to dihydrotestosterone by 5alpha-reductase. All these events take place during weeks 8-12 of gestation, a narrow window of sexual differentiation. Recent studies in human fetal development have demonstrated the early fetal expression of the adrenocorticotrophic hormone (ACTH) receptor and all steroidogenic components necessary for the biosynthesis of cortisol. These findings provide compelling evidence for the assumed pathogenesis of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, diminished feedback to the pituitary due to glucocorticoid deficiency, subsequent ACTH excess, and up-regulation of adrenal androgen production with subsequent virilization. Another CAH variant, P450 oxidoreductase deficiency, manifests with 46,XX disorder of sex development (DSD), i.e., virilized female genitalia, despite concurrently low circulating androgens. This CAH variant illustrates the existence of an alternative pathway toward the biosynthesis of active androgens in humans which is active in human fetal life only. Thus CAH teaches important lessons from nature, providing privileged insights into the window of human sexual differentiation, and particularly highlighting the importance of steroidogenesis in the process of human sexual differentiation.
    Original languageEnglish
    Pages (from-to)393-401
    Number of pages9
    JournalBest practice & research. Clinical endocrinology & metabolism
    Issue number3
    Publication statusPublished - 1 Sept 2007


    • dehydroepiandrosterone
    • fetal adrenal
    • cortisol
    • testosterone
    • DHEA
    • urogenital ridge
    • 17alpha-hydroxylase
    • CAH
    • sex development
    • CYP17AI
    • fetal gonad
    • bitpotent gonad
    • POR
    • congenital adrenal hyperplasia
    • P450 oxidoreductase
    • 2I-hydroxylase
    • androgen
    • P450 oxidoreductase deficiency
    • CYP2/A2


    Dive into the research topics of 'Age-specific changes in sex steroid biosynthesis and sex development'. Together they form a unique fingerprint.

    Cite this