Figure 5.2. CAH: the metabolic pathway in the synthesis of cortisol. Cortisol is a steroid hormone that involved a five step metabolic process beginning with cholesterol. If there is a block at any one of the five steps, then some form of CAH will result. Hence, CAH exhibits genetic heterogeneity. The five enzymes in the production of cortisol are given on the left. The major symptoms of CAH for each step are given ion the right of the step (red = appearance of the genitalia, green = androgen level, blue = major medical complication).