Condition | Comments |
Transient central adrenal insufficiency (due to pituitary or hypothalamic suppression)* | |
Cessation of chronic high-dose glucocorticoid therapy | Most common cause of central adrenal insufficiency. These drugs reversibly suppress the hypothalamic-pituitary-adrenal axis. |
After cure of Cushing syndrome
| Elevated concentrations of cortisol suppress hypothalamic production of CRH, which, in turn, inhibits ACTH production from corticotroph cells. |
Medications¶ | |
| A high-dose progestin with glucocorticoid activity[1]. Adrenal insufficiency may occur during therapy or upon withdrawal. |
| Related to cumulative opioid dose[2]. |
| Anti-progestational agent and glucocorticoid receptor antagonist. |
| Inhibit glucocorticoid-induced gene transcription. |
| Possible central effect[3]. |
| Hypophysitis; hypopituitarism[4]. |
Anorexia nervosa | Adrenal insufficiency is rare, although some hypothalamic dysfunction is common. |
Critical illness-related corticosteroid insufficiency (CIRCI) | CIRCI has characteristics of central adrenal insufficiency, with complex dysregulation of the HPA axis[5]. CIRCI also involves primary adrenal dysfunction and tissue corticosteroid resistance. |
Permanent central adrenal insufficiency (due to pituitary and/or hypothalamic dysfunction) | |
Congenital | |
Brain malformationsΔ
| Optic nerve hypoplasia is associated with a variety of CNS and endocrine abnormalities, some with syndromic features. |
Syndromes with hypothalamic dysfunction
| |
Genetic causes of pituitary hormone deficiencies
| Variable phenotypes, with single or multiple pituitary hormone deficiencies including ACTH deficiency, with variable order of onset and variable severity[6,7]. |
Acquired | |
Brain lesion or injuryΔ
| Multiple pituitary hormones may be affected (GH, LH, FSH, TSH, ACTH, and/or ADH). The most common deficits are GH, LH, and FSH, causing growth abnormalities and delayed puberty, respectively. However, these disorders also may be rarely associated with precocious puberty, the mechanism of which is unknown. |
Infiltrative diseasesΔ
|
ACTH: adrenocorticotropic hormone; CRH: corticotropin-releasing hormone; CIRCI: critical illness-related corticosteroid insufficiency; HPA: hypothalamic-pituitary-adrenal; CNS: central nervous system; ROHHAD: rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation; CPHD: combined pituitary hormone deficiency; GH: growth hormone; LH: luteinizing hormone; FSH: follicle-stimulating hormone; TSH: thyroid-stimulating hormone; ADH: antidiuretic hormone (vasopressin).
* These disorders cause temporary isolated ACTH deficiency due to suppression of hypothalamic CRH secretion.
¶ Refer to UpToDate content on causes of secondary and tertiary adrenal insufficiency in adults.
Δ These brain disorders may cause adrenal insufficiency by interfering with pituitary ACTH secretion (secondary adrenal insufficiency) or with hypothalamic CRH secretion (tertiary adrenal insufficiency).Do you want to add Medilib to your home screen?