Box 2.
Primary adrenal insufficiency

  • Autoimmune: Isolated adrenal insufficiency (Addison's), APS1 (adrenal insufficiency + hypoparathyroidism + mucocutaenous candidiasis), APS2 (adrenal insufficiency + thyroid disease [Schmidt's syndrome] + Type 1 diabetes [Carpenter's syndrome])

  • Infections: Tuberculosis, fungal infiltration, AIDS

  • Genetic: Adrenoleukodystrophy, congenital adrenal hyperplasia, adrenal hypoplasia congenita

  • Vascular: Adrenal infarction / haemorrhage (Waterhouse-Friedrichson syndrome in meningococcal sepsis)

  • Infiltrative: Metastasis, lymphoma, sarcoidosis, amyloidosis, haemachromatosis

  • Iatrogenic: Surgical adrenalectomy or drug induced (eg mitotate, etomidate, ketoconazole, immunotherapy)

Secondary adrenal insufficiency

  • Tumour: Pituitary macroadenoma, other tumour (craniopharyngioma, meningioma)

  • Iatrogenic: Pituitary irradiation, drugs (opioids, glucocorticoids, immunotherapy)

  • Vascular: Apoplexy, Sheehan's syndrome

  • Infiltrative: Tuberculosis, sarcoidosis, histiocytosis X, granulomatosis with polyangiitis, lymphocytic hypophysitis

  • Trauma

  • Genetic

  • APS = autoimmune polyendocrine syndromes.