aetiology

Last reviewed 07/2021

The most common causes are:

• autoimmune adrenalitis - 80% of cases
• it can occur as part of autoimmune polyendocrine syndrome
• autoimmune polyendocrine syndrome type I (APS type 1)
• around 80% of patients with APS type I develop Addison’s
• autoimmune polyendocrine syndrome type II (APS type 2) (1)
• historically, tuberculosis but less common today
• still the most common cause in many developing countries
• recently a resurgence of tuberculous adrenalitis has been noticed due to an increase in patients with acquired immunodeficiency syndrome (1).
• bilateral adrenalectomy for malignant disease
• cessation of therapeutic corticosteroids or failure to increase dose to cover stress

Less common causes include:

• infections:
• fungal diseases e.g. histoplasmosis
• bacterial e.g. Waterhouse-Friedrichson syndrome
• cytomegalovirus infection in AIDS

• infiltration:
• amyloidosis
• sarcoidosis
• haemochromatosis
• metastatic carcinoma (bronchus, breast, malignant melanoma)

• drugs - rifampicin, etomidate, ketoconazole

• congenital adrenal hyperplasia

• congenital adrenal hypoplasia - X linked

• haemorrhage into the adrenal glands:
• during breech delivery
• complication of anticoagulation therapy

• adrenoleukodystrophy

• adrenal vein thrombosis after trauma, adrenal venography

• apparent insufficiency - pseudohypoaldosteronism

Reference:

• (1) Leelarathna L, Powrie JK, Carroll PV. Thomas Addison's disease after 154 years: modern diagnostic perspectives on an old condition. QJM. 2009;102(8):569-73
• (2) Bornstein SR. Predisposing factors for adrenal insufficiency. N Engl J Med. 2009;360(22):2328-39