Adrenal insufficiency

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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]

Classification

'''Adrenal insufficiency''' is classified based on the location of the pathology into: "Adrenal Insufficiency - Endotext - NCBI Bookshelf".

• Primary adrenal insufficiency (Addison's disease).
• Secondary adrenal insufficiency.
• Tertiary adrenal insufficiency.

In Primary adrenal insufficiency, the pathology lies in the adrenal glands. The most common cause of primary adrenal insufficiency is autoimmune adrenalitis. In secondary adrenal insufficiency, the pathology lies in the pituitary gland, whereas in tertiary adrenal insufficiency the pathology lies in the hypothalamus. The most common cause of tertiary adrenal insufficiency is chronic glucocorticoid therapy. Secondary and tertiary adrenal insufficiency together are categorised into central adrenal insufficiency. The following table summaries the causes of adrenal insufficiency.

Causes of adrenal insufficiency
Primary adrenal insufficiency (Addison's disease)	Secondary adrenal insufficiency	Tertiary adrenal insufficiency
Autoimmune: Sporadic Autoimmune polyendocrine syndrome type 1 (APS type 1) Autoimmune polyendocrine syndrome type 2 (Schmidt's syndrome) Infections: Tuberculosis, Fungal infections, Cytomegalovirus, HIV Adrenal Metastasis Adrenal infiltration Adrenal hemorrhage: Waterhouse-Friderichsen syndrome, Drugs - Anticoagulants- Heparin, Warfarin) Adrenoleukodystrophy Congenital adrenal hypoplasia Bilateral adrenelectomy	Pituitary tumors Iatrogeneic: Pituitary surgery, Pituitary radiation Granulomatous diseases: Tuberculosis Sarcoidosis Histiocytosis Wegener's granulomatosis Metastasis Pituitary apoplexy Sheehan's syndrome (Peripartum pituitary necrosis) Genetic: Isolated ACTH deficiency, Multiple pituitary hormone deficiencies Trauma	Glucocorticoid therapy Cushing's syndrome (Excess endogenous glucocorticoid production) Drugs: Mifepristone Chlorpromazine Imipramine Hypothalamic tumors (Primary and metastatic) Iatrogenic: Hypothalamic surgery Hypothalamic radiation Granulomatous diseases: Tuberculosis Sarcoidosis Histiocytosis Wegener's granulomatosis Trauma

Diagnosis

Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Interventions | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1