Secondary adrenal insufficiency classification

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

Classification

There are three major types of adrenal insufficiency.

• Primary adrenal insufficiency is due to impairment of the adrenal glands.
  • One subtype is called idiopathic or unknown cause of adrenal insufficiency.
  • 80% are due to an autoimmune disease called Addison's disease or autoimmune adrenalitis.
  • Other cases are due to congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland.
• Secondary adrenal insufficiency is caused by impairment of the pituitary gland or hypothalamus. The most common cause in the United States is exogenous steroid use. Other causes are a pituitary adenoma or microadenoma, hypothalamic tumor (surgical removal of a pituitary tumor can also suppress production of ACTH and lead to adrenal deficiency); Sheehan's syndrome, which is associated with impairment of only the pituitary gland.
• Tertiary adrenal insufficiency is due to hypothalamic disease and decrease in corticotropin releasing factor (CRF).