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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The most common causes are:

  • autoimmune adrenalitis - 80% of cases
    • it can occur as part of autoimmune polyendocrine syndrome
      • autoimmune polyendocrine syndrome type I (APS type 1)
        • around 80% of patients with APS type I develop Addison’s
      • autoimmune polyendocrine syndrome type II (APS type 2) (1)
  • historically, tuberculosis but less common today
    • still the most common cause in many developing countries
    • recently a resurgence of tuberculous adrenalitis has been noticed due to an increase in patients with acquired immunodeficiency syndrome (1).
  • bilateral adrenalectomy for malignant disease
  • cessation of therapeutic corticosteroids or failure to increase dose to cover stress

Less common causes include:

  • infections:
    • fungal diseases e.g. histoplasmosis
    • bacterial e.g. Waterhouse-Friedrichson syndrome
    • cytomegalovirus infection in AIDS

  • infiltration:
    • amyloidosis
    • sarcoidosis
    • haemochromatosis
    • metastatic carcinoma (bronchus, breast, malignant melanoma)

  • drugs - rifampicin, etomidate, ketoconazole

  • congenital adrenal hyperplasia

  • congenital adrenal hypoplasia - X linked

  • haemorrhage into the adrenal glands:
    • during breech delivery
    • complication of anticoagulation therapy

  • adrenoleukodystrophy

  • adrenal vein thrombosis after trauma, adrenal venography

  • apparent insufficiency - pseudohypoaldosteronism


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