Secondary adrenal insufficiency pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

• Primary adrenal insufficiency:

Here the defect lies in the adrenal glands. Autoantibodies, infections, drugs and mutations cause destruction of the adrenal glands leading to deficiency of adrenal hormones and thus causing symptoms.

• Secondary adrenal insufficiency:

ACTH deficiency caused by diseases of the pituitary gland is the main cause for adrenal insufficiency. ACTH deficiency leads to loss of stimulus for the production of adrenal hormones. ACTH levels in the blood can differentiate primary adrenal insufficiency from the secondary form. In the primary form the ACTH levels are high because of the loss of negative feedback from the adrenal hormones.

• Tertiary adrenal insufficiency:

The hypothalamus in the brain secretes a hormone called corticotropin releasing factor (CRF). This hormone provides the necessary stimulus to the pituitary for secreting ACTH which in turn activates the process of production of adrenal hormones. In diseases of the hypothalamus, the CRF is not produced leading to a decreased production of ACTH and in turn the adrenal hormones.