aetiology

Last reviewed 07/2021

Causes of acute hypoadrenalism include:

• drug related:
• abrupt withdrawal of steroids from patients with adrenal atrophy secondary to chronic steroid administration
• steroid synthesis inhibiting drugs given to patients with congenital adrenal hyperplasia
• steroid metabolism increasing drugs given to patients with decreased adrenocortical reserve
• adrenal crisis - rapid and overwhelming intensification of chronic adrenal insufficiency - may follow trauma, severe hypotension and sepsis
• an acute haemorrhagic destruction of both adrenal glands:
• newborn - birth trauma
• children - usually associated with septicaemia with Pseudomonas or with meningococcaemia (Waterhouse - Friederichsen syndrome)
• adults - anticoagulant therapy or a coagulation disorder during stress
• pregnancy - idiopathic adrenal vein thrombosis; complication of venography
• surgical adrenalectomy e.g. for breast cancer
• pituitary necrosis e.g. Sheehan's syndrome
• inadequate steroid replacement during surgery