Hypoadrenalism (chronic, secondary)

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-.