Cholesterol is synthesized primarily in the liver, intestines, skin, and adrenal cortex. Its synthesis involves multiple steps starting from acetyl CoA and requiring 18 acetyl CoA molecules, 36 ATP molecules, and 16 NADPH molecules to produce one molecule of cholesterol. The major sites of cholesterol synthesis are the liver, intestines, skin, and adrenal cortex. Cholesterol contains 27 carbon atoms, with a hydroxyl group and eight carbon side chain that are characteristic of its structure.