Commonest causes of adrenal insufficiency. Adapted from Charmandari et al7
| Cause | Examples and notes |
|---|---|
| Primary adrenal insufficiency | |
| Autoimmune/Addison's Disease | |
| APS Type 1 (APECED) | |
| APS Type 2 | |
| Infections (adrenalitis) | TB, HIV/AIDS, CMV, fungal infections, syphilis |
| Bilateral adrenal haemorrhage | Adrenal haemorrhage sepsis, anticoagulants, anti-phospholipid syndrome |
| Bilateral adrenal metastases | Primarily metastases from lung, stomach, breast and colon cancers |
| Bilateral adrenal infiltration | Primary adrenal lymphoma amyloidosis, haemochromatosis |
| Bilateral adrenalectomy | |
| Drug induced | Anticoagulants, adrenal enzyme inhibitors: mitotane, ketoconazole, itraconazole, voriconazole, metyrapone, etomidate, aminoglutethimidie, phenobarbital, phenytoin, rifampicin |
| Genetic disorders | Congenital adrenal hyperplasia (commonest cause in children), adrenoleukodystrophy |
| Secondary adrenal insufficiency/pituitary disorders | |
| Pituitary tumours | Adenoma, cysts, craniopharyngioma, ependymoma, meningioma, pituitary metastases |
| Pituitary surgery | |
| Pituitary irradiation | |
| Trauma | |
| Infections/infiltration | Lymphocytic hypophysitis, sarcoidosis, histiocytosis X, haemochromatosis, TB |
| Pituitary apoplexy | |
| Sheehan's syndrome | |
| Genetic disorders | Transcription factors involved in pituitary development |
| Tertiary adrenal insufficiency | |
| Hypothalamic tumours | Craniopharyngiomas, germinomas, meningiomas |
| Hypothalamaic surgery | Primary brain tumours or nasopharyngeal tumours |
| Hypothalamic irradiation | Primary brain tumours or nasopharyngeal tumours |
| Infections/infiltration | Lymphocytic hypophysitis, sarcoidosis, histiocytosis X, haemochromatosis, TB |
| Trauma | Traumatic brain injury, particularly base of skull fracture |
| Cushing's disease/syndrome | |
| Drug induced | Glucocorticoid therapy (any route), mifepristone, chlorpromazine, imipramine |