Aetiology

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