Etiologies-adrenal insufficiency

• Primary = adrenocortical disease = Addison’s disease autoimmune: isolated or in assoc w/ APS (see table on page 7-2) infection: TB, CMV, histoplasmosis, paracoccidioidomycosis vascular: hemorrhage (usually in setting of sepsis), adrenal vein thrombosis, HIT, trauma metastatic disease: (90% of adrenals must be destroyed to cause insufficiency) deposition diseases: hemochromatosis, amyloidosis, sarcoidosis drugs: azole antifungals, etomidate (even after single dose), rifampin, anticonvulsants
• Secondary = pituitary failure of ACTH secretion (but adrenal aldosterone intact b/c RAA axis) any cause of primary or secondary hypopituitarism (see “Pituitary Disorders”) glucocorticoid therapy (can occur after ≤2 wk of “suppressive doses”; dose effect variable; even <10 mg of prednisone daily chronically can be suppressive) megestrol (a progestin with some glucocorticoid activity)