Secondary adrenal insufficiency classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

• Adrenal insufficiency may be classified according to location of the pathology into 3 subtypes: primary, secondary and tertiary.

• Primary adrenal insufficiency can be acute or chronic.

Classification

• Primary adrenal insufficiency

is due to impairment of the adrenal glands. 80% are due to an autoimmune disease called Addison's disease or autoimmune adrenalitis. One subtype is called idiopathic, meaning of unknown cause. Other cases are due to congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland.

• Secondary adrenal insufficiency

caused by impairment of the pituitary gland or hypothalamus.[2] Its principal causes include pituitary adenoma (which can suppress production of adrenocorticotropic hormone (ACTH) and lead to adrenal deficiency unless the endogenous hormones are replaced); and Sheehan's syndrome, which is associated with impairment of only the pituitary gland.

• Tertiary adrenal insufficiency

due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH).[3] Causes can include brain tumors and sudden withdrawal from long-term exogenous steroid use (which is the most common cause).[4]