Adrenal insufficiency

Hypoadrenalism includes all conditions in which the secretion of adrenal steroid hormones falls below that required by the body.

One classification is that of:

• acute
• chronic:
  • primary adrenal insufficiency - Addison's disease
    • primary adrenal insufficiency, which involves deficiency of all adrenocortical hormones, is caused by (1)
      • autoimmune destruction
      • congenital adrenal hyperplasia
      • pharmacological inhibition (eg, high doses of azole antifungal therapy)
      • infection (eg, tuberculosis, fungal infections)
      • surgical removal of adrenal cortical tissue
  • secondary adrenal insufficiency
    • secondary adrenal insufficiency is caused by disorders affecting the pituitary gland, such as (1):
      • tumours,
      • haemorrhage
      • inflammatory or infiltrative conditions (eg, hypophysitis, sarcoidosis, hemochromatosis)
      • surgery
      • radiation therapy
      • or medications that suppress corticotropin production, such as opioids
    • glucocorticoid-induced adrenal insufficiency is caused by administration of supra-physiological doses of glucocorticoids

Reference:

1. Vaidya A, Findling J, Bancos I. Adrenal Insufficiency in Adults: A Review. JAMA. 2025;334(8):714–725.