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Reliable, easy-to-read patient information on common medical conditions β€” written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Secondary adrenal insufficiency causes

Introduction

Overview

Overview

Secondary adrenal insufficiency is caused mainly by four categories, hypopituitarism, drugs, genetic and other causes. Life-threatening causes include acute withdrawal of steroids, adrenal hemorrhage, Waterhouse-Friderichson syndrome, anticoagulation and gastroenteritis which causes adrenal crisis. The common causes include chronic steroid therapy and its withdrawal, opiates, causes of panhypopituitarism and the less common causes are genetic causes which include combined pituitary hormone deficiency (CPHD), proopiomelanocortin deficiency POMC and isolated ACTH deficiency.

Causes

Causes

Life-threatening Causes

Life-threatening causes of secondary adrenal insufficiency include causes of acute adrenal crisis/insufficiency:

Common Causes

Secondary adrenal insufficiency may be caused by:

Less Common Causes

Less common causes of secondary adrenal insufficiency include:

Causes by Organ System

Cardiovascular Arteritis, Hypotension, Hemorrhage, Infarction
Chemical / poisoning No underlying causes
Dermatologic POEMS syndrome
Drug Side Effect Aminoglutethimide, Ciclesonide, Cidofovir, Corticosteroid withdrawal, Dexamethasone, Flunisolide, Pembrolizumab,prednisolone, Trilostane
Ear Nose Throat No underlying causes
Endocrine Allgrove syndrome, Achalasia-addisonian syndrome, Adrenal aplasia / adrenal hypoplasia, Adrenal metastases, After surgery of cortisol-secreting tumor, Autoimmune polyendocrine syndrome type 2, Bilateral adrenalectomy , Congenital adrenal hyperplasia, Glucocorticoid deficiency 1, IMAGE syndrome, POEMS syndrome, X-linked adrenal hypoplasia congenita
Environmental No underlying causes
Gastroenterologic Allgrove syndrome, Achalasia-addisonian syndrome, Hemochromatosis
Genetic Congenital adrenal hyperplasia, Cytochrome P450 oxidoreductase deficiency, Glycerol kinase deficiency, Hereditary ACTH resistance, IMAGE syndrome, X-linked adrenal hypoplasia congenita, Combined pituitary hormone deficiency (CPHD), Proopiomelanocortin deficiency (POMC), Isolated ACTH deficiency
Hematologic Anticoagulation, Coagulopathy , Embolus, Leukemia, Lymphoma , Thrombosis
Iatrogenic Iatrogenic, Radiation therapy, Chronic steroid therapy
Infectious Disease AIDS, Blastomycosis, CMV, Coccidiomycosis, Cryptococcosis, Histoplasmosis , Mycobacterium avium intracellulaire (MAI), Sepsis, Syphilis, Toxoplasmosis, Tuberculosis, Waterhouse-Friderichson syndrome
Musculoskeletal / Ortho IMAGE syndrome
Neurologic Adrenoleukodystrophy, Coma, Craniopharyngioma, Panhypopituitarism, POEMS syndrome
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Craniopharyngioma, Kaposi’s sarcoma, Leukemia, Lymphoma , pituitary metastasis
Ophthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Sarcoidosis,
Renal / Electrolyte Uremia, Waterhouse-Friderichson syndrome
Rheum / Immune / Allergy Autoimmune, Autoimmune polyendocrine syndrome type 2, Sarcoidosis
Sexual No underlying causes
Trauma Trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Amyloidosis, Idiopathic, Iatrogenic, Radiation therapy, Surgery, Surgical removal of pituitary, Surgical removal of hypothalamus

Causes in Alphabetical Order

References

References

  1. ↑ Ham PB, Cunningham AJ, Mentzer CJ, Ahmad A, Young LS, Abuzeid AM (2015). “Traumatic panhypopituitarism resulting in acute adrenal crisis”. J Trauma Acute Care Surg. 79 (3): 484–9. doi:10.1097/TA.0000000000000771. PMIDΒ 26307884.
  2. ↑ Puar TH, Stikkelbroeck NM, Smans LC, Zelissen PM, Hermus AR (2016). “Adrenal Crisis: Still a Deadly Event in the 21st Century”. Am J Med. 129 (3): 339.e1–9. doi:10.1016/j.amjmed.2015.08.021. PMIDΒ 26363354.
  3. ↑ “www.ucdenver.edu” (PDF).
  4. ↑ 4.0 4.1 Huebner A, Yoon SJ, Ozkinay F, Hilscher C, Lee H, Clark AJ; et al. (2000). “Triple A syndrome–clinical aspects and molecular genetics”. Endocr Res. 26 (4): 751–9. PMIDΒ 11196451.
  5. ↑ Mosser J, Douar AM, Sarde CO, Kioschis P, Feil R, Moser H; et al. (1993). “Putative X-linked adrenoleukodystrophy gene shares unexpected homology with ABC transporters”. Nature. 361 (6414): 726–30. doi:10.1038/361726a0. PMIDΒ 8441467.
  6. ↑ Shashidhar PK, Shashikala GV (2012). “Low dose adrenocorticotropic hormone test and adrenal insufficiency in critically ill acquired immunodeficiency syndrome patients”. Indian J Endocrinol Metab. 16 (3): 389–94. doi:10.4103/2230-8210.95680. PMCΒ 3354846. PMIDΒ 22629505.
  7. ↑ Eledrisi MS, Verghese AC (2001). “Adrenal insufficiency in HIV infection: a review and recommendations”. Am. J. Med. Sci. 321 (2): 137–44. PMIDΒ 11217816.
  8. ↑ Cocco C, Meloni A, Mariotti S; et al. (2012). “Novel neuronal and endocrine autoantibody targets in autoimmune polyendocrine syndrome type 1”. Autoimmunity. 45 (6): 485–94. doi:10.3109/08916934.2012.680632. PMIDΒ 22506635.
  9. ↑ Osa SR, Peterson RE, Roberts RB (1981). “Recovery of adrenal reserve following treatment of disseminated South American blastomycosis”. Am. J. Med. 71 (2): 298–301. PMIDΒ 6266250.
  10. ↑ Ardalan M, Shoja MM (2009). “Cytomegalovirus-induced adrenal insufficiency in a renal transplant recipient”. Transplant. Proc. 41 (7): 2915–6. doi:10.1016/j.transproceed.2009.07.024. PMIDΒ 19765472.
  11. ↑ Mihalache A, Lamy O, Waeber G, Schneider A (2007). “[Adrenal insufficiency and hypercalcemia–an unusual presentation]”. Praxis (Bern 1994) (in German). 96 (45): 1761–5. PMIDΒ 18050601.
  12. ↑ Kawamura M, Miyazaki S, Mashiko S; et al. (1998). “Disseminated cryptococcosis associated with adrenal masses and insufficiency”. Am. J. Med. Sci. 316 (1): 60–4. PMIDΒ 9671046.
  13. ↑ Turan S, Hughes C, Atay Z; et al. (2012). “An atypical case of familial glucocorticoid deficiency without pigmentation caused by coexistent homozygous mutations in MC2R (T152K) and MC1R (R160W)”. J. Clin. Endocrinol. Metab. 97 (5): E771–4. doi:10.1210/jc.2011-2414. PMCΒ 3396854. PMIDΒ 22337906.
  14. ↑ Francke U, Harper JF, Darras BT; et al. (1987). “Congenital adrenal hypoplasia, myopathy, and glycerol kinase deficiency: molecular genetic evidence for deletions”. Am. J. Hum. Genet. 40 (3): 212–27. PMCΒ 1684111. PMIDΒ 2883886.
  15. ↑ Pedersen-Bjergaard U, Thorsteinsson B, Kirkegaard BC (1996). “[Pituitary function in hemochromatosis]”. Ugeskr. Laeg. (in Danish). 158 (13): 1818–22. PMIDΒ 8650756.
  16. ↑ Pedreira CC, Savarirayan R, Zacharin MR (2004). “IMAGe syndrome: a complex disorder affecting growth, adrenal and gonadal function, and skeletal development”. J. Pediatr. 144 (2): 274–7. doi:10.1016/j.jpeds.2003.09.052. PMIDΒ 14760276.
  17. ↑ Weits J, Sprenger HG, Ilic P, van Klingeren B, Elema JD, Steensma JT (1991). “[Mycobacterium avium disease in AIDS patients; diagnosis and therapy]”. Ned Tijdschr Geneeskd (in Dutch; Flemish). 135 (52): 2485–9. PMIDΒ 1758516.
  18. ↑ Dispenzieri A, Kyle RA, Lacy MQ; et al. (2003). “POEMS syndrome: definitions and long-term outcome”. Blood. 101 (7): 2496–506. doi:10.1182/blood-2002-07-2299. PMIDΒ 12456500.
  19. ↑ Gostiljac DM, DordeviΔ‡ PB, Maric-zivkoviΔ‡ J, CanoviΔ‡ F (2005). “[Sarcoidosis localized in endocrine glands]”. Med. Pregl. 58 Suppl 1: 25–9. PMIDΒ 16526262.


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]