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.
The patient’s eye doctor should evaluate the degree of ocular inflammation and determine presence of iris or angle neovascularization (by gonioscopy), pigment suggestive of pigment-dispersion syndrome or pseudo exfoliation, blood in Schlemm's canal, peripheral anterior synechiae (PAS), etc. Measure IOP, and inspect the optic nerve. Optic disc photographs are obtained, and formal visual-field (., Humphrey, Octopus) examination performed when the optic nerve appears damaged or when the duration of IOP increase is prolonged or unknown.
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