Biosynthesis of steroid hormones requires a battery of oxidative enzymes located in both mitochondria and endoplasmic reticulum. The rate-limiting step in this process is the transport of free cholesterol from the cytoplasm into mitochondria. Within mitochondria, cholesterol is converted to pregnenolone by an enzyme in the inner membrane called CYP11A1. Pregnenolone itself is not a hormone, but is the immediate precursor for the synthesis of all of the steroid hormones. The following table delineates the enzymes required to synthesize the major classes of steroid hormones.
The levels of hormones in the body can be regulated by several factors. The nervous system can control hormone levels through the action of the hypothalamus and its releasing and inhibiting hormones. For example, TRH produced by the hypothalamus stimulates the anterior pituitary to produce TSH. Tropic hormones provide another level of control for the release of hormones. For example, TSH is a tropic hormone that stimulates the thyroid gland to produce T3 and T4. Nutrition can also control the levels of hormones in the body. For example, the thyroid hormones T3 and T4 require 3 or 4 iodine atoms, respectively, to be produced. In people lacking iodine in their diet, they will fail to produce sufficient levels of thyroid hormones to maintain a healthy metabolic rate. Finally, the number of receptors present in cells can be varied by cells in response to hormones. Cells that are exposed to high levels of hormones for extended periods of time can begin to reduce the number of receptors that they produce, leading to reduced hormonal control of the cell.
Dermatologic: alopecia, urticaria, skin rashes, toxic epidermal necrolysis, erythema multiforme, erythema nodosum, fixed drug eruption, lichen planus, pustular reaction, systemic lupus erythematoses, bullous reactions, including Stevens-Johnson syndrome, photosensitive dermatitis, photosensitivity reactions, including rare cases resembling porphyria cutanea tarda (pseudoporphyria) or epidermolysis bullosa. If skin fragility, blistering or other symptoms suggestive of pseudoporphyria occur, treatment should be discontinued and the patient monitored.