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Hypoadrenalism (chronic, secondary)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Adrenal atrophy from long term exogenous corticosteroid therapy is the most common cause of hypoadrenalism whether primary or secondary

  • iatrogenic, tertiary adrenal insufficiency induced by chronic administration of high doses of glucocorticoids is the most common cause of adrenal insufficiency (1)

Other causes of secondary hypoadrenalism include:

  • pituitary lesions:
    • pituitary surgery
    • irradiation
    • adenoma
    • pituitary apoplexy
    • granulomatous disease e.g. sarcoidosis
    • metastases
    • Sheehan's syndrome (rare)
    • idiopathic isolated ACTH deficiency (very rare)
  • hypothalamic and mid-brain lesions:
    • surgery & head injury
    • tumour e.g. craniopharyngioma
    • cranial irradiation
    • granulomatous disease

Reference:

  • Nicolaides NC, Pavlaki AN, Maria Alexandra MA, et al. Glucocorticoid Therapy and Adrenal Suppression. [Updated 2018 Oct 19]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.

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