Secondary adrenal insufficiency classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].

OR

[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].

OR

Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.

OR

If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].

OR

The staging of [malignancy name] is based on the [staging system].

OR

There is no established system for the staging of [malignancy name].

Classification

Adrenal insufficiency is classified into 3 types based on level of impairment.

• Primary adrenal insufficiency

It is due to impairment of the adrenal glands. 80% are due to an autoimmune disease called Addison's disease or autoimmune adrenalitis. One subtype is called idiopathic, meaning of unknown cause. Other cases are due to congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland.

• Secondary adrenal insufficiency

It is caused by impairment of the pituitary gland or hypothalamus.[2] Its principal causes include pituitary adenoma (which can suppress production of adrenocorticotropic hormone (ACTH) and lead to adrenal deficiency unless the endogenous hormones are replaced); and Sheehan's syndrome, which is associated with impairment of only the pituitary gland.

• Tertiary adrenal insufficiency

It is due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH). Causes can include brain tumors and sudden withdrawal from long-term exogenous steroid use (which is the most common cause).[4]

Adrenal Insufficiency

Primary adrenal insufficiency

Secondary adrenal insufficiency

Tertiary adrenal insufficiency

•Addison's disease •Autoimmune adrenalitis •Idiopathic

Hypopituitarism •Tumors-Craniopharyngioma •Infections- Tuberculosis, Histoplasmosis •Pituitary infarction-Sheehan's syndrome, Pituitary apoplexy •Removal of pituitary due to metatstasis •Lymphycytic hypophysitis •Head trauma •Intracranial artery aneurysms Drugs •Megestrol •Opiates- Codeine, Morphine

Hypothalamic-Pituitary axis (HPA) suppression • Chronic High-dose steroids • Abrupt withdrawal of Steroids