In this study various C27 sterols with a 3-oxo-4-ene structure were incubated with adrenal cortex mitochondrial preparations. (22R)-22-Hydroxy-4-cholesten-3-one and (20R,22R)-20,22-dihydroxy-4-cholesten-3-one were found to be converted into progesterone. This suggests the existence of a pathway for adrenal progesterone formation analogous to the normal 3 beta-hydroxy-5-ene pathways. (20S)-20-Hydroxy-4-cholesten-3-one was hydroxylated at C25. 4-Cholesten-3-one, 25-hydroxy-4-cholesten-3-one and (22S)-22-hydroxy-4-cholesten-3-one were not converted to a measurable extent. With 3-oxo-4-ene C27 sterols as substrates, the cholesterol side-chain cleaving enzyme system seems to require the presence of a 22R-hydroxyl group in the substrate. The clinical relevance of these observations is discussed.