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Causes of acute hypoadrenalism include:

  • 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:
    • newborn - 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

Last reviewed 07/2021