Secondary adrenal insufficiency causes: Difference between revisions

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__NOTOC__
__NOTOC__
{{Adrenal insufficiency}}
{{Secondary adrenal insufficiency}}
{{CMG}}
{{CMG}} {{AE}} {{ADS}}


==Overview==
==Overview==
Secondary adrenal insufficiency is caused mainly by four categories, [[hypopituitarism]], [[Drug|drugs]], [[Genetics|genetic]] and other causes. Life-threatening causes include acute withdrawal of [[steroids]], [[adrenal hemorrhage]], [[Waterhouse-Friderichson syndrome]], anticoagulation and [[gastroenteritis]] which causes [[adrenal crisis]]. The common causes include chronic [[steroid]] therapy and its withdrawal, [[opiates]], causes of [[panhypopituitarism]] and the less common causes are [[Genetics|genetic]] causes which include combined pituitary hormone deficiency (CPHD), [[proopiomelanocortin]] deficiency [[POMC]] and isolated [[Adrenocorticotropic hormone|ACTH]] deficiency.


== Causes ==
== Causes ==
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Life-threatening causes of secondary adrenal insufficiency include causes of acute [[adrenal crisis]]/insufficiency:
Life-threatening causes of secondary adrenal insufficiency include causes of acute [[adrenal crisis]]/insufficiency:
* Acute withdrawal of [[steroids]].
* Acute withdrawal of [[steroids]].
* Traumatic hypopituitarism.<ref name="pmid26307884">{{cite journal| author=Ham PB, Cunningham AJ, Mentzer CJ, Ahmad A, Young LS, Abuzeid AM| title=Traumatic panhypopituitarism resulting in acute adrenal crisis. | journal=J Trauma Acute Care Surg | year= 2015 | volume= 79 | issue= 3 | pages= 484-9 | pmid=26307884 | doi=10.1097/TA.0000000000000771 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26307884  }} </ref>
* Traumatic [[hypopituitarism]].<ref name="pmid26307884">{{cite journal| author=Ham PB, Cunningham AJ, Mentzer CJ, Ahmad A, Young LS, Abuzeid AM| title=Traumatic panhypopituitarism resulting in acute adrenal crisis. | journal=J Trauma Acute Care Surg | year= 2015 | volume= 79 | issue= 3 | pages= 484-9 | pmid=26307884 | doi=10.1097/TA.0000000000000771 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26307884  }} </ref>
* [[Adrenal hemorrhage]]
* [[Adrenal hemorrhage]]
** [[Waterhouse-Friderichson syndrome]]
** [[Waterhouse-Friderichson syndrome]]
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Secondary adrenal insufficiency may be caused by:
Secondary adrenal insufficiency may be caused by:
*Drugs
*Drugs
**Chronic steroid therapy and its withdrawal
**Chronic [[steroid]] therapy and its withdrawal  
**[[Opiates]]
**[[Opiates]]
**[[Etomidate]]
**Antifungals- [[ketoconazole]]<ref name="urlwww.ucdenver.edu">{{cite web |url=http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/intmed/imrp/CURRICULUM/Documents/Bornstein%20SR--Predisposing%20Factors%20to%20Adrenal%20Insuff%202009.pdf |title=www.ucdenver.edu |format= |work= |accessdate=}}</ref>
*Pituitary causes:
*Pituitary causes:
**Infections
**Infections- [[tuberculosis]]
**Tumors- [[craniopharyngioma]]
**Pituitary infarction
**Pituitary infarction
***Pituitary apoplexy
***[[Pituitary apoplexy]]
***[[Sheehan's syndrome]]
***[[Sheehan's syndrome]]
**Pituitary removal
**Pituitary removal
**Pituitary irradiation


===Less Common Causes===
===Less Common Causes===
Less common causes of secondary adrenal insufficiency include:
Less common causes of secondary adrenal insufficiency include:
*Pituitary causes
*Pituitary causes
**Lymphocytic hypophysitis
**[[Hypophysitis|Lymphocytic hypophysitis]]
**Tumors- [[craniopharyngioma]], [[metastasis]],
 
*Genetic causes:
*Genetic causes:
**Combined pituitary hormone deficiency (CPHD)
**Combined pituitary hormone deficiency (CPHD)
**[[Proopiomelanocortin]] deficiency ([[POMC]])
**[[Proopiomelanocortin]] deficiency ([[POMC]])
**Isolated ACTH deficiency
**Isolated [[ACTH]] deficiency


===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Arteritis]], [[Hypotension]], [[Hemorrhage]], [[Infarction]]
| style="width:75%" bgcolor="Beige" ; border="1" | [[Arteritis]], [[Hypotension]], [[Hemorrhage]], [[Infarction]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| [[POEMS syndrome]]
| bgcolor="Beige" | [[POEMS syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Aminoglutethimide]], [[Ciclesonide]], [[Cidofovir]], [[Corticosteroid]] withdrawal, [[Dexamethasone]], [[Flunisolide]], [[Pembrolizumab]],[[prednisolone]], [[Trilostane]]
| bgcolor="Beige" | [[Aminoglutethimide]], [[Ciclesonide]], [[Cidofovir]], [[Corticosteroid]] withdrawal, [[Dexamethasone]], [[Flunisolide]], [[Pembrolizumab]],[[prednisolone]], [[Trilostane]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| [[Allgrove syndrome]], [[Achalasia-addisonian syndrome]], [[Adrenal aplasia]] / [[adrenal hypoplasia]], [[Adrenal metastases]], After surgery of [[cortisol-secreting tumor]], [[Autoimmune polyendocrine syndrome type 2]], [[Bilateral adrenalectomy ]], [[Congenital adrenal hyperplasia]], [[Glucocorticoid deficiency 1]], [[IMAGE syndrome]], [[POEMS syndrome]], [[X-linked adrenal hypoplasia congenita]]
| bgcolor="Beige" | [[Allgrove syndrome]], [[Achalasia-addisonian syndrome]], [[Adrenal aplasia]] / [[adrenal hypoplasia]], [[Adrenal metastases]], After surgery of [[cortisol-secreting tumor]], [[Autoimmune polyendocrine syndrome type 2]], [[Bilateral adrenalectomy ]] , [[Congenital adrenal hyperplasia]], [[Glucocorticoid deficiency 1]], [[IMAGE syndrome]], [[POEMS syndrome]], [[X-linked adrenal hypoplasia congenita]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Allgrove syndrome]], [[Achalasia-addisonian syndrome]], [[Hemochromatosis ]]
| bgcolor="Beige" | [[Allgrove syndrome]], [[Achalasia-addisonian syndrome]], [[Hemochromatosis ]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| [[Congenital adrenal hyperplasia]], [[Cytochrome P450 oxidoreductase deficiency]], [[Glycerol kinase deficiency]], [[Hereditary ACTH resistance]], [[IMAGE syndrome]], [[X-linked adrenal hypoplasia congenita]], Combined pituitary hormone deficiency (CPHD), [[Proopiomelanocortin]] deficiency ([[POMC]]), Isolated ACTH deficiency
| bgcolor="Beige" | [[Congenital adrenal hyperplasia]], [[Cytochrome P450 oxidoreductase deficiency]], [[Glycerol kinase deficiency]], [[Hereditary ACTH resistance]], [[IMAGE syndrome]], [[X-linked adrenal hypoplasia congenita]], Combined pituitary hormone deficiency (CPHD), [[Proopiomelanocortin]] deficiency ([[POMC]]), Isolated ACTH deficiency
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| [[Anticoagulation]], [[Coagulopathy ]], [[Embolus]], [[Leukemia]], [[Lymphoma ]], [[Thrombosis]]
| bgcolor="Beige" | [[Anticoagulation]], [[Coagulopathy ]] , [[Embolus]], [[Leukemia]], [[Lymphoma ]] , [[Thrombosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| [[Iatrogenic]], [[Radiation therapy]], Chronic steroid therapy
| bgcolor="Beige" | [[Iatrogenic]], [[Radiation therapy]], Chronic steroid therapy
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[AIDS]], [[Blastomycosis]], [[CMV]], [[Coccidiomycosis]], [[Cryptococcosis]], [[Histoplasmosis ]], [[Mycobacterium avium intracellulaire]] ([[MAI]]), [[Sepsis]], [[Syphilis]], [[Toxoplasmosis]], [[Tuberculosis]], [[Waterhouse-Friderichson syndrome ]]
| bgcolor="Beige" | [[AIDS]], [[Blastomycosis]], [[CMV]], [[Coccidiomycosis]], [[Cryptococcosis]], [[Histoplasmosis ]] , [[Mycobacterium avium intracellulaire]] ([[MAI]]), [[Sepsis]], [[Syphilis]], [[Toxoplasmosis]], [[Tuberculosis]], [[Waterhouse-Friderichson syndrome ]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[IMAGE syndrome]]
| bgcolor="Beige" | [[IMAGE syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| [[Adrenoleukodystrophy]], [[Coma]], [[Craniopharyngioma]], [[Panhypopituitarism]], [[POEMS syndrome]]
| bgcolor="Beige" | [[Adrenoleukodystrophy]], [[Coma]], [[Craniopharyngioma]], [[Panhypopituitarism]], [[POEMS syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| [[Craniopharyngioma]], [[Kaposi's sarcoma]], [[Leukemia]], [[Lymphoma ]], pituitary [[metastasis]]
| bgcolor="Beige" | [[Craniopharyngioma]], [[Kaposi's sarcoma]], [[Leukemia]], [[Lymphoma ]] , pituitary [[metastasis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| [[Sarcoidosis]],
| bgcolor="Beige" | [[Sarcoidosis]],
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Uremia]], [[Waterhouse-Friderichson syndrome ]]
| bgcolor="Beige" | [[Uremia]], [[Waterhouse-Friderichson syndrome ]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Autoimmune]], [[Autoimmune polyendocrine syndrome type 2]], [[Sarcoidosis]]
| bgcolor="Beige" | [[Autoimmune]], [[Autoimmune polyendocrine syndrome type 2]], [[Sarcoidosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| [[Trauma]]
| bgcolor="Beige" | [[Trauma]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
| '''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| [[Amyloidosis]], [[Idiopathic]], [[Iatrogenic]], [[Radiation therapy]], [[Surgery]], Surgical removal of [[pituitary]], Surgical removal of [[hypothalamus]]
| bgcolor="Beige" | [[Amyloidosis]], [[Idiopathic]], [[Iatrogenic]], [[Radiation therapy]], [[Surgery]], Surgical removal of [[pituitary]], Surgical removal of [[hypothalamus]]
|-
|-
|}
|}
Line 154: Line 159:
===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{MultiCol}}
{{MultiCol}}
*[[Achalasia-addisonian syndrome]]<ref name="pmid11196451">{{cite journal |author=Huebner A, Yoon SJ, Ozkinay F, ''et al.'' |title=Triple A syndrome--clinical aspects and molecular genetics |journal=Endocr. Res. |volume=26 |issue=4 |pages=751–9 |year=2000 |month=November |pmid=11196451 |doi= |url=}}</ref>
*[[Achalasia-addisonian syndrome]]<ref name="pmid11196451">{{cite journal| author=Huebner A, Yoon SJ, Ozkinay F, Hilscher C, Lee H, Clark AJ et al.| title=Triple A syndrome--clinical aspects and molecular genetics. | journal=Endocr Res | year= 2000 | volume= 26 | issue= 4 | pages= 751-9 | pmid=11196451 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11196451  }} </ref>
*[[Adrenal aplasia]] / [[Adrenal hypoplasia]]
*[[Adrenal aplasia]] / [[Adrenal hypoplasia]]
*[[Adrenal metastases]]
*[[Adrenal metastases]]
*[[Adrenoleukodystrophy]]<ref name="pmid8441467">{{cite journal |author=Mosser J, Douar AM, Sarde CO, ''et al.'' |title=Putative X-linked adrenoleukodystrophy gene shares unexpected homology with ABC transporters |journal=Nature |volume=361 |issue=6414 |pages=726–30 |year=1993 |month=February |pmid=8441467 |doi=10.1038/361726a0 |url=}}</ref>
*[[Adrenoleukodystrophy]]<ref name="pmid8441467">{{cite journal| author=Mosser J, Douar AM, Sarde CO, Kioschis P, Feil R, Moser H et al.| title=Putative X-linked adrenoleukodystrophy gene shares unexpected homology with ABC transporters. | journal=Nature | year= 1993 | volume= 361 | issue= 6414 | pages= 726-30 | pmid=8441467 | doi=10.1038/361726a0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8441467  }} </ref>
*After surgery of [[cortisol-secreting tumor]]
*After surgery of [[cortisol-secreting tumor]]
*[[AIDS]]<ref name="pmid22629505">{{cite journal |author=Shashidhar PK, Shashikala GV |title=Low dose adrenocorticotropic hormone test and adrenal insufficiency in critically ill acquired immunodeficiency syndrome patients |journal=Indian J Endocrinol Metab |volume=16 |issue=3 |pages=389–94 |year=2012 |month=May |pmid=22629505 |pmc=3354846 |doi=10.4103/2230-8210.95680 |url=}}</ref><ref name="pmid11217816">{{cite journal |author=Eledrisi MS, Verghese AC |title=Adrenal insufficiency in HIV infection: a review and recommendations |journal=Am. J. Med. Sci. |volume=321 |issue=2 |pages=137–44 |year=2001 |month=February |pmid=11217816 |doi= |url=}}</ref>
*[[AIDS]]<ref name="pmid22629505">{{cite journal |author=Shashidhar PK, Shashikala GV |title=Low dose adrenocorticotropic hormone test and adrenal insufficiency in critically ill acquired immunodeficiency syndrome patients |journal=Indian J Endocrinol Metab |volume=16 |issue=3 |pages=389–94 |year=2012 |pmid=22629505 |pmc=3354846 |doi=10.4103/2230-8210.95680 |url=}}</ref><ref name="pmid11217816">{{cite journal |author=Eledrisi MS, Verghese AC |title=Adrenal insufficiency in HIV infection: a review and recommendations |journal=Am. J. Med. Sci. |volume=321 |issue=2 |pages=137–44 |year=2001 |pmid=11217816 |doi= |url=}}</ref>
*[[Allgrove syndrome]]<ref name="pmid11196451">{{cite journal |author=Huebner A, Yoon SJ, Ozkinay F, ''et al.'' |title=Triple A syndrome--clinical aspects and molecular genetics |journal=Endocr. Res. |volume=26 |issue=4 |pages=751–9 |year=2000 |month=November |pmid=11196451 |doi= |url=}}</ref>
*[[Allgrove syndrome]]<ref name="pmid11196451">{{cite journal |author=Huebner A, Yoon SJ, Ozkinay F, ''et al.'' |title=Triple A syndrome--clinical aspects and molecular genetics |journal=Endocr. Res. |volume=26 |issue=4 |pages=751–9 |year=2000 |month=November |pmid=11196451 |doi= |url=}}</ref>
*[[Aminoglutethimide]]
*[[Aminoglutethimide]]
Line 166: Line 171:
*[[Arteritis]]
*[[Arteritis]]
*[[Autoimmune]]
*[[Autoimmune]]
*[[Autoimmune polyendocrine syndrome type 2]]<ref name="pmid22506635">{{cite journal |author=Cocco C, Meloni A, Mariotti S, ''et al.'' |title=Novel neuronal and endocrine autoantibody targets in autoimmune polyendocrine syndrome type 1 |journal=Autoimmunity |volume=45 |issue=6 |pages=485–94 |year=2012 |month=September |pmid=22506635 |doi=10.3109/08916934.2012.680632 |url=}}</ref>
*[[Autoimmune polyendocrine syndrome type 2]]<ref name="pmid22506635">{{cite journal |author=Cocco C, Meloni A, Mariotti S, ''et al.'' |title=Novel neuronal and endocrine autoantibody targets in autoimmune polyendocrine syndrome type 1 |journal=Autoimmunity |volume=45 |issue=6 |pages=485–94 |year=2012 |pmid=22506635 |doi=10.3109/08916934.2012.680632 |url=}}</ref>
*[[Bilateral adrenalectomy]]
*[[Bilateral adrenalectomy]]
*[[Blastomycosis]]<ref name="pmid6266250">{{cite journal |author=Osa SR, Peterson RE, Roberts RB |title=Recovery of adrenal reserve following treatment of disseminated South American blastomycosis |journal=Am. J. Med. |volume=71 |issue=2 |pages=298–301 |year=1981 |month=August |pmid=6266250 |doi= |url=}}</ref>
*[[Blastomycosis]]<ref name="pmid6266250">{{cite journal |author=Osa SR, Peterson RE, Roberts RB |title=Recovery of adrenal reserve following treatment of disseminated South American blastomycosis |journal=Am. J. Med. |volume=71 |issue=2 |pages=298–301 |year=1981 |pmid=6266250 |doi= |url=}}</ref>
*[[CMV]]<ref name="pmid19765472">{{cite journal |author=Ardalan M, Shoja MM |title=Cytomegalovirus-induced adrenal insufficiency in a renal transplant recipient |journal=Transplant. Proc. |volume=41 |issue=7 |pages=2915–6 |year=2009 |month=September |pmid=19765472 |doi=10.1016/j.transproceed.2009.07.024 |url=}}</ref>
*[[CMV]]<ref name="pmid19765472">{{cite journal |author=Ardalan M, Shoja MM |title=Cytomegalovirus-induced adrenal insufficiency in a renal transplant recipient |journal=Transplant. Proc. |volume=41 |issue=7 |pages=2915–6 |year=2009 |pmid=19765472 |doi=10.1016/j.transproceed.2009.07.024 |url=}}</ref>
*[[Coagulopathy]]
*[[Coagulopathy]]
*[[Coccidiomycosis]]
*[[Coccidiomycosis]]
Line 176: Line 181:
*[[Congenital adrenal hyperplasia]]
*[[Congenital adrenal hyperplasia]]
*[[Corticosteroid]] withdrawal
*[[Corticosteroid]] withdrawal
*[[Craniopharyngioma]]<ref name="pmid18050601">{{cite journal |author=Mihalache A, Lamy O, Waeber G, Schneider A |title=[Adrenal insufficiency and hypercalcemia--an unusual presentation] |language=German |journal=Praxis (Bern 1994) |volume=96 |issue=45 |pages=1761–5 |year=2007 |month=November |pmid=18050601 |doi= |url=}}</ref>
*[[Craniopharyngioma]]<ref name="pmid18050601">{{cite journal |author=Mihalache A, Lamy O, Waeber G, Schneider A |title=[Adrenal insufficiency and hypercalcemia--an unusual presentation] |language=German |journal=Praxis (Bern 1994) |volume=96 |issue=45 |pages=1761–5 |year=2007 |pmid=18050601 |doi= |url=}}</ref>
*[[Cryptococcosis]]<ref name="pmid9671046">{{cite journal |author=Kawamura M, Miyazaki S, Mashiko S, ''et al.'' |title=Disseminated cryptococcosis associated with adrenal masses and insufficiency |journal=Am. J. Med. Sci. |volume=316 |issue=1 |pages=60–4 |year=1998 |month=July |pmid=9671046 |doi= |url=}}</ref>
*[[Cryptococcosis]]<ref name="pmid9671046">{{cite journal |author=Kawamura M, Miyazaki S, Mashiko S, ''et al.'' |title=Disseminated cryptococcosis associated with adrenal masses and insufficiency |journal=Am. J. Med. Sci. |volume=316 |issue=1 |pages=60–4 |year=1998 |pmid=9671046 |doi= |url=}}</ref>
*[[Cytochrome P450 oxidoreductase deficiency]]
*[[Cytochrome P450 oxidoreductase deficiency]]
*[[Embolus]]
*[[Embolus]]
*[[Flunisolide]]
*[[Flunisolide]]
*[[Glucocorticoid deficiency 1]]<ref name="pmid22337906">{{cite journal |author=Turan S, Hughes C, Atay Z, ''et al.'' |title=An atypical case of familial glucocorticoid deficiency without pigmentation caused by coexistent homozygous mutations in MC2R (T152K) and MC1R (R160W) |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=5 |pages=E771–4 |year=2012 |month=May |pmid=22337906 |pmc=3396854 |doi=10.1210/jc.2011-2414 |url=}}</ref>
*[[Glucocorticoid deficiency 1]]<ref name="pmid22337906">{{cite journal |author=Turan S, Hughes C, Atay Z, ''et al.'' |title=An atypical case of familial glucocorticoid deficiency without pigmentation caused by coexistent homozygous mutations in MC2R (T152K) and MC1R (R160W) |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=5 |pages=E771–4 |year=2012 |pmid=22337906 |pmc=3396854 |doi=10.1210/jc.2011-2414 |url=}}</ref>
*[[Glycerol kinase deficiency]]<ref name="pmid2883886">{{cite journal |author=Francke U, Harper JF, Darras BT, ''et al.'' |title=Congenital adrenal hypoplasia, myopathy, and glycerol kinase deficiency: molecular genetic evidence for deletions |journal=Am. J. Hum. Genet. |volume=40 |issue=3 |pages=212–27 |year=1987 |month=March |pmid=2883886 |pmc=1684111 |doi= |url=}}</ref>
*[[Glycerol kinase deficiency]]<ref name="pmid2883886">{{cite journal |author=Francke U, Harper JF, Darras BT, ''et al.'' |title=Congenital adrenal hypoplasia, myopathy, and glycerol kinase deficiency: molecular genetic evidence for deletions |journal=Am. J. Hum. Genet. |volume=40 |issue=3 |pages=212–27 |year=1987 |pmid=2883886 |pmc=1684111 |doi= |url=}}</ref>
*[[Hemochromatosis]]<ref name="pmid8650756">{{cite journal |author=Pedersen-Bjergaard U, Thorsteinsson B, Kirkegaard BC |title=[Pituitary function in hemochromatosis] |language=Danish |journal=Ugeskr. Laeg. |volume=158 |issue=13 |pages=1818–22 |year=1996 |month=March |pmid=8650756 |doi= |url=}}</ref>
*[[Hemochromatosis]]<ref name="pmid8650756">{{cite journal |author=Pedersen-Bjergaard U, Thorsteinsson B, Kirkegaard BC |title=[Pituitary function in hemochromatosis] |language=Danish |journal=Ugeskr. Laeg. |volume=158 |issue=13 |pages=1818–22 |year=1996 |pmid=8650756 |doi= |url=}}</ref>
{{ColBreak}}
{{ColBreak}}
*[[Hemorrhage]]
*[[Hemorrhage]]
Line 191: Line 196:
*[[Iatrogenic]]
*[[Iatrogenic]]
*[[Idiopathic]]
*[[Idiopathic]]
*[[IMAGE syndrome]]<ref name="pmid14760276">{{cite journal |author=Pedreira CC, Savarirayan R, Zacharin MR |title=IMAGe syndrome: a complex disorder affecting growth, adrenal and gonadal function, and skeletal development |journal=J. Pediatr. |volume=144 |issue=2 |pages=274–7 |year=2004 |month=February |pmid=14760276 |doi=10.1016/j.jpeds.2003.09.052 |url=}}</ref>
*[[IMAGE syndrome]]<ref name="pmid14760276">{{cite journal |author=Pedreira CC, Savarirayan R, Zacharin MR |title=IMAGe syndrome: a complex disorder affecting growth, adrenal and gonadal function, and skeletal development |journal=J. Pediatr. |volume=144 |issue=2 |pages=274–7 |year=2004 |pmid=14760276 |doi=10.1016/j.jpeds.2003.09.052 |url=}}</ref>
*[[Infarction]]
*[[Infarction]]
*Isolated ACTH deficiency
*Isolated ACTH deficiency
Line 197: Line 202:
*[[Leukemia]]
*[[Leukemia]]
*[[Lymphoma]]
*[[Lymphoma]]
*[[Mycobacterium avium intracellulaire]] ([[MAI]])<ref name="pmid1758516">{{cite journal |author=Weits J, Sprenger HG, Ilic P, van Klingeren B, Elema JD, Steensma JT |title=[Mycobacterium avium disease in AIDS patients; diagnosis and therapy] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=135 |issue=52 |pages=2485–9 |year=1991 |month=December |pmid=1758516 |doi= |url=}}</ref>
*[[Metastasis]]
*[[Mycobacterium avium intracellulaire]] ([[MAI]])<ref name="pmid1758516">{{cite journal |author=Weits J, Sprenger HG, Ilic P, van Klingeren B, Elema JD, Steensma JT |title=[Mycobacterium avium disease in AIDS patients; diagnosis and therapy] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=135 |issue=52 |pages=2485–9 |year=1991 |pmid=1758516 |doi= |url=}}</ref>
*[[Panhypopituitarism]]
*[[Panhypopituitarism]]
*[[POEMS syndrome]]<ref name="pmid12456500">{{cite journal |author=Dispenzieri A, Kyle RA, Lacy MQ, ''et al.'' |title=POEMS syndrome: definitions and long-term outcome |journal=Blood |volume=101 |issue=7 |pages=2496–506 |year=2003 |month=April |pmid=12456500 |doi=10.1182/blood-2002-07-2299 |url=}}</ref>
*[[POEMS syndrome]]<ref name="pmid12456500">{{cite journal |author=Dispenzieri A, Kyle RA, Lacy MQ, ''et al.'' |title=POEMS syndrome: definitions and long-term outcome |journal=Blood |volume=101 |issue=7 |pages=2496–506 |year=2003 |pmid=12456500 |doi=10.1182/blood-2002-07-2299 |url=}}</ref>
*[[Proopiomelanocortin]] deficiency ([[POMC]])
*[[Proopiomelanocortin]] deficiency ([[POMC]])
*[[Radiation therapy]]
*[[Radiation therapy]]
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[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Needs overview]]

Latest revision as of 14:57, 17 November 2017

Secondary adrenal insufficiency Microchapters

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

Overview

Secondary adrenal insufficiency is caused mainly by four categories, hypopituitarism, drugs, genetic and other causes. Life-threatening causes include acute withdrawal of steroids, adrenal hemorrhage, Waterhouse-Friderichson syndrome, anticoagulation and gastroenteritis which causes adrenal crisis. The common causes include chronic steroid therapy and its withdrawal, opiates, causes of panhypopituitarism and the less common causes are genetic causes which include combined pituitary hormone deficiency (CPHD), proopiomelanocortin deficiency POMC and isolated ACTH deficiency.

Causes

Life-threatening Causes

Life-threatening causes of secondary adrenal insufficiency include causes of acute adrenal crisis/insufficiency:

Common Causes

Secondary adrenal insufficiency may be caused by:

Less Common Causes

Less common causes of secondary adrenal insufficiency include:

Causes by Organ System

Cardiovascular Arteritis, Hypotension, Hemorrhage, Infarction
Chemical / poisoning No underlying causes
Dermatologic POEMS syndrome
Drug Side Effect Aminoglutethimide, Ciclesonide, Cidofovir, Corticosteroid withdrawal, Dexamethasone, Flunisolide, Pembrolizumab,prednisolone, Trilostane
Ear Nose Throat No underlying causes
Endocrine Allgrove syndrome, Achalasia-addisonian syndrome, Adrenal aplasia / adrenal hypoplasia, Adrenal metastases, After surgery of cortisol-secreting tumor, Autoimmune polyendocrine syndrome type 2, Bilateral adrenalectomy , Congenital adrenal hyperplasia, Glucocorticoid deficiency 1, IMAGE syndrome, POEMS syndrome, X-linked adrenal hypoplasia congenita
Environmental No underlying causes
Gastroenterologic Allgrove syndrome, Achalasia-addisonian syndrome, Hemochromatosis
Genetic Congenital adrenal hyperplasia, Cytochrome P450 oxidoreductase deficiency, Glycerol kinase deficiency, Hereditary ACTH resistance, IMAGE syndrome, X-linked adrenal hypoplasia congenita, Combined pituitary hormone deficiency (CPHD), Proopiomelanocortin deficiency (POMC), Isolated ACTH deficiency
Hematologic Anticoagulation, Coagulopathy , Embolus, Leukemia, Lymphoma , Thrombosis
Iatrogenic Iatrogenic, Radiation therapy, Chronic steroid therapy
Infectious Disease AIDS, Blastomycosis, CMV, Coccidiomycosis, Cryptococcosis, Histoplasmosis , Mycobacterium avium intracellulaire (MAI), Sepsis, Syphilis, Toxoplasmosis, Tuberculosis, Waterhouse-Friderichson syndrome
Musculoskeletal / Ortho IMAGE syndrome
Neurologic Adrenoleukodystrophy, Coma, Craniopharyngioma, Panhypopituitarism, POEMS syndrome
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Craniopharyngioma, Kaposi's sarcoma, Leukemia, Lymphoma , pituitary metastasis
Ophthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Sarcoidosis,
Renal / Electrolyte Uremia, Waterhouse-Friderichson syndrome
Rheum / Immune / Allergy Autoimmune, Autoimmune polyendocrine syndrome type 2, Sarcoidosis
Sexual No underlying causes
Trauma Trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Amyloidosis, Idiopathic, Iatrogenic, Radiation therapy, Surgery, Surgical removal of pituitary, Surgical removal of hypothalamus

Causes in Alphabetical Order


References

  1. ↑ Ham PB, Cunningham AJ, Mentzer CJ, Ahmad A, Young LS, Abuzeid AM (2015). "Traumatic panhypopituitarism resulting in acute adrenal crisis". J Trauma Acute Care Surg. 79 (3): 484–9. doi:10.1097/TA.0000000000000771. PMID 26307884.
  2. ↑ Puar TH, Stikkelbroeck NM, Smans LC, Zelissen PM, Hermus AR (2016). "Adrenal Crisis: Still a Deadly Event in the 21st Century". Am J Med. 129 (3): 339.e1–9. doi:10.1016/j.amjmed.2015.08.021. PMID 26363354.
  3. ↑ "www.ucdenver.edu" (PDF).
  4. ↑ 4.0 4.1 Huebner A, Yoon SJ, Ozkinay F, Hilscher C, Lee H, Clark AJ; et al. (2000). "Triple A syndrome--clinical aspects and molecular genetics". Endocr Res. 26 (4): 751–9. PMID 11196451.
  5. ↑ Mosser J, Douar AM, Sarde CO, Kioschis P, Feil R, Moser H; et al. (1993). "Putative X-linked adrenoleukodystrophy gene shares unexpected homology with ABC transporters". Nature. 361 (6414): 726–30. doi:10.1038/361726a0. PMID 8441467.
  6. ↑ Shashidhar PK, Shashikala GV (2012). "Low dose adrenocorticotropic hormone test and adrenal insufficiency in critically ill acquired immunodeficiency syndrome patients". Indian J Endocrinol Metab. 16 (3): 389–94. doi:10.4103/2230-8210.95680. PMC 3354846. PMID 22629505.
  7. ↑ Eledrisi MS, Verghese AC (2001). "Adrenal insufficiency in HIV infection: a review and recommendations". Am. J. Med. Sci. 321 (2): 137–44. PMID 11217816.
  8. ↑ Cocco C, Meloni A, Mariotti S; et al. (2012). "Novel neuronal and endocrine autoantibody targets in autoimmune polyendocrine syndrome type 1". Autoimmunity. 45 (6): 485–94. doi:10.3109/08916934.2012.680632. PMID 22506635.
  9. ↑ Osa SR, Peterson RE, Roberts RB (1981). "Recovery of adrenal reserve following treatment of disseminated South American blastomycosis". Am. J. Med. 71 (2): 298–301. PMID 6266250.
  10. ↑ Ardalan M, Shoja MM (2009). "Cytomegalovirus-induced adrenal insufficiency in a renal transplant recipient". Transplant. Proc. 41 (7): 2915–6. doi:10.1016/j.transproceed.2009.07.024. PMID 19765472.
  11. ↑ Mihalache A, Lamy O, Waeber G, Schneider A (2007). "[Adrenal insufficiency and hypercalcemia--an unusual presentation]". Praxis (Bern 1994) (in German). 96 (45): 1761–5. PMID 18050601.
  12. ↑ Kawamura M, Miyazaki S, Mashiko S; et al. (1998). "Disseminated cryptococcosis associated with adrenal masses and insufficiency". Am. J. Med. Sci. 316 (1): 60–4. PMID 9671046.
  13. ↑ Turan S, Hughes C, Atay Z; et al. (2012). "An atypical case of familial glucocorticoid deficiency without pigmentation caused by coexistent homozygous mutations in MC2R (T152K) and MC1R (R160W)". J. Clin. Endocrinol. Metab. 97 (5): E771–4. doi:10.1210/jc.2011-2414. PMC 3396854. PMID 22337906.
  14. ↑ Francke U, Harper JF, Darras BT; et al. (1987). "Congenital adrenal hypoplasia, myopathy, and glycerol kinase deficiency: molecular genetic evidence for deletions". Am. J. Hum. Genet. 40 (3): 212–27. PMC 1684111. PMID 2883886.
  15. ↑ Pedersen-Bjergaard U, Thorsteinsson B, Kirkegaard BC (1996). "[Pituitary function in hemochromatosis]". Ugeskr. Laeg. (in Danish). 158 (13): 1818–22. PMID 8650756.
  16. ↑ Pedreira CC, Savarirayan R, Zacharin MR (2004). "IMAGe syndrome: a complex disorder affecting growth, adrenal and gonadal function, and skeletal development". J. Pediatr. 144 (2): 274–7. doi:10.1016/j.jpeds.2003.09.052. PMID 14760276.
  17. ↑ Weits J, Sprenger HG, Ilic P, van Klingeren B, Elema JD, Steensma JT (1991). "[Mycobacterium avium disease in AIDS patients; diagnosis and therapy]". Ned Tijdschr Geneeskd (in Dutch; Flemish). 135 (52): 2485–9. PMID 1758516.
  18. ↑ Dispenzieri A, Kyle RA, Lacy MQ; et al. (2003). "POEMS syndrome: definitions and long-term outcome". Blood. 101 (7): 2496–506. doi:10.1182/blood-2002-07-2299. PMID 12456500.
  19. ↑ Gostiljac DM, Dordević PB, Maric-zivković J, Canović F (2005). "[Sarcoidosis localized in endocrine glands]". Med. Pregl. 58 Suppl 1: 25–9. PMID 16526262.


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