Adrenal gland & paraganglia

Adrenal insufficiency

Secondary adrenal insufficiency

Topic Completed: 1 February 2005

Minor changes: 18 December 2020

Copyright: 2002-2019,, Inc.

PubMed Search: Secondary adrenocortical insufficiency

Nat Pernick, M.D.
Page views in 2020: 458
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Cite this page: Pernick N. Secondary adrenal insufficiency. website. Accessed December 4th, 2021.
Definition / general
  • Caused by any disorder of pituitary gland which decreases ACTH production and causes adrenal cortical atrophy
  • Causes: pituitary macroadenoma, craniopharyngioma, tuberculosis or other infections, sarcoidosis, lymphocytic hypophysitis, head trauma, aneurysms, postpartum pituitary necrosis (Sheehan syndrome), pituitary apoplexy or metastases; also mutations in pro-opiomelanocortin gene
  • Tertiary adrenocortical insufficiency: due to disorders of hypothalamus reducing release of corticotropin releasing hormone (CRH); some include this within secondary adrenocortical insufficiency
  • Similar atrophic changes are caused by exogenous steroids, which also decrease ACTH production
  • No hyperpigmentation since ACTH levels are low
  • Laboratory: serum aldosterone, sodium and potassium levels are usually normal, since they are controlled by renin-angiotensin axis, which is not under the control of ACTH; androgens and cortisol levels are low since their production is influenced by ACTH, although androgens are less affected in males since they are also produced by testis; hypoglycemia is more common than with primary adrenal insufficiency
  • May be associated with hypopituitarism
  • Exogenous ACTH causes rise in serum cortisol levels
  • May also need to replace other pituitary hormones
Gross description
  • Atrophic adrenal glands with retention of architecture, often fibrotic capsule, bright yellow (due to lipid accumulation) and prominent medulla
Microscopic (histologic) description
  • Normal thickness of zona glomerulosa, thinner fasciculata and reticularis
  • Usually no lymphoplasmacytic infiltration
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