Adrenal insufficiency causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayeesha Kattubadi, M.B.B.S[2] Muhammad Saad, M.B.B.S.[3]

Overview

Common causes of adrenal insufficiency include autoimmune adrenalitis and chronic glucocorticoid use.

Causes

Life threatening cause

• Adrenal crisis is a life-threatening cause of adrenal insufficiency.

Common Causes

Common causes of adrenal insufficiency include:

• Primary adrenal insufficiency: Autoimmune adrenalitis
• Central adrenal insufficiency: Chronic glucocorticoid use.

Less Common Causes

Less common causes of adrenal insufficiency include:

• Infections:
  • Tuberculosis
  • Fungal infections(histoplasma)
  • Cytomegalovirus
  • HIV
• Adrenal hemorrhage
• X-linked adrenoleukodystrophy
• Trauma
• Metastasis

The following table summarizes the causes of adrenal insufficiency.

Causes of adrenal insufficiency
Primary adrenal insufficiency	Secondary adrenal insufficiency	Glucocorticoid induced adrenal insufficiency
Autoimmune(67%-90%) Isolated Polyglandular syndrome type 1 Polyglandular syndrome type 2 Congenital adrenal hyperplasia (5.4%-10%) 21-Hydroxylase deficiency 11β- Hydroxylase deficiency 3β-Hydroxylase deficiency 17𝜶-Hydroxylase Deficiency Other Infectious (<5%) Tuberculosis Fungal(histoplasmosis, cryptococcosis, coccidiomycosis, blastomycosis) Viral(cytomegalovirus, HIV) Infiltrative (<5%) Metastases Adrenal lymphoma Sarcoidosis Amyloidosis Medications (<5%) Antifungals(azoles) Mitotane Abiraterone acetate Metyrapone Osilodrostat Mifepristone Immunotherapies(ipilimumab, nivolimumab, pembrolizumab) Heparin Etomidate Other Hemorrhage Surgical Resection	Tumors Pituitary adenoma Pituitary carcinoma Craniopharyngioma Primary CNS tumor Metastatic Lesions Trauma/injury/hemorrhage Pituitary trauma CNS hemorrhage Sheehan syndrome Radiation Hypophysitis Primary autoimmune hypophysitis Drug induced hypophysitis(ipilimumab, pembrolizumab, atezolizumab) Infiltrative Langerhans cell histiocytosis Amyloidosis Hemochromatosis Sarcoidosis Medications Opioids Megesterol acetate Other Hemorrhage Surgical resection	Exogenous glucocorticoids Oral Intravenous Inhaled Intranasal Intra-articular Topical