The prior measurement of cortisol had a different methodology and was done using Luminescent Immunoassay (LIA). Therefore, many changes can be attributed to methodology, the platform used and differing reagents. The new reference ranges are provided in the Salimetrics kit and apply to this new methodology. To further validate the new reference ranges, we tested a population of apparently healthy patients aged 18-65, whose prior cortisol and DHEA samples reflected normal ranges and followed the normal diurnal pattern. Even with the expansion of the age group, extrapolation of the results showed no statistical change. The Salimetics kit and these reference ranges are considered FDA equivalent.
Much of our modern understanding and treatment of CAH comes from research conducted at Johns Hopkins Medical School in Baltimore in the middle of the 20th century. Lawson Wilkins , "founder" of pediatric endocrinology , worked out the apparently paradoxical pathophysiology: that hyperplasia and overproduction of adrenal androgens resulted from impaired capacity for making cortisol. He reported use of adrenal cortical extracts to treat children with CAH in 1950. Genital reconstructive surgery was also pioneered at Hopkins. After application of karyotyping to CAH and other intersex disorders in the 1950s, John Money , JL Hampson, and JG Hampson persuaded both the scientific community and the public that sex assignment should not be based on any single biological criterion, and gender identity was largely learned and has no simple relationship with chromosomes or hormones. See Intersex for a fuller history, including recent controversies over reconstructive surgery.
The early steps in the biosynthesis of steroids of both plants and animals are the same, except that in plants lanosterol is replaced by the related compound cycloartenol, which contains a three-membered ring (C9, C10, C19) in lieu of the nuclear double bond of lanosterol. The side chains of the phytosterols, such as stigmasterol, and of the sterol ergosterol of yeasts and other fungi contain extra carbon atoms that are incorporated in reactions involving S -adenosylmethionine, which donates methyl groups in numerous biological processes. Although most plant tissues contain only traces of cholesterol, this sterol is the biogenetic precursor of such important plant steroids as the sapogenins , glycosides , and alkaloids . Because pregnane derivatives are intermediates in some of these transformations, plants and animals appear to have important features of steroid metabolism in common.