Aetiology

Causes of acute hypoadrenalism include: (1,2)

• drug related:
  • abrupt withdrawal of steroids from patients with adrenal atrophy secondary to chronic steroid administration
  • steroid synthesis inhibiting drugs given to patients with congenital adrenal hyperplasia
  • steroid metabolism increasing drugs given to patients with decreased adrenocortical reserve
• adrenal crisis - rapid and overwhelming intensification of chronic adrenal insufficiency - may follow trauma, severe hypotension and sepsis
• an acute haemorrhagic destruction of both adrenal glands:
  • new born - birth trauma
  • children - usually associated with septicaemia with Pseudomonas or with meningococcaemia (Waterhouse - Friederichsen syndrome)
  • adults - anticoagulant therapy or a coagulation disorder during stress
  • pregnancy - idiopathic adrenal vein thrombosis; complication of venography
• surgical adrenalectomy e.g. for breast cancer
• pituitary necrosis e.g. Sheehan's syndrome
• inadequate steroid replacement during surgery

Reference

1. Husebye ES, Pearce SH, Krone NP, et al. Adrenal insufficiency. Lancet. 2021 Feb 13;397(10274):613-29.
2. Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015 Mar;3(3):216-26