Cells of the zona fasciculata and zona reticularis lack aldosterone synthase (CYP11B2) that converts corticosterone to aldosterone, and thus these tissues produce only the weak mineralocorticoid corticosterone. However, both these zones do contain the CYP17A1 missing in zona glomerulosa and thus produce the major glucocorticoid, cortisol. Zona fasciculata and zona reticularis cells also contain CYP17A1, whose 17,20-lyase activity is responsible for producing the androgens, dehydroepiandosterone (DHEA) and androstenedione. Thus, fasciculata and reticularis cells can make corticosteroids and the adrenal androgens, but not aldosterone.
Background: Systemic corticosteroid injections are used to treat a variety of medical conditions. Inaccurate placement of intramuscular injections of corticosteroid can result in local lipoatrophy, and a resultant cosmetic deformity. Objective: Describe the condition, and a simple, reproducible method of correcting the volume deficiency and skin changes associated with steroid induced lipoatrophy Methods: A retrospective chart review was undertaken of all patients treated by the author for steroid induced lipoatrophy between June of 2005 and March of 2011. Results: Structural fat grafting was used to treat 11 patients with steroid induced lipoatrophy during this time period. 10 patients were female and one was male. 9 of the patients had atrophy of the buttock or hip, and 2 had atrophy of the upper extremity. All patients had satisfactory correction of their deformities, and only one of the patients required a second grafting session to achieve an adequate volume for complete correction. Conclusions: Structural fat grafting can eliminate the volume deficiency and skin changes associated with steroid induced lipoatrophy. It is a straightforward, well tolerated method for correcting a problem which can be quite cosmetically deforming.