HYPOADRENALISM

1° adrenal disease [raised serum ACTH; skin pigmentation; hypotension]:

acquired (Addison's disease):

autoimmune disease of adrenal glands [commonest cause in developed countries]

tuberculosis [commonest cause world-wide]

bilateral adrenalectomy

metastatic carcinoma

fungal infection

amyloidosis

haemochromatosis

adrenal infarction or haemorrhage, eg. Waterhouse-Friderichsen syndrome in meningococcal septicaemia

congenital adrenal hyperplasia [various defects; features and severity vary]

2° adrenal insufficiency [low serum ACTH; blood pressure maintained; pallor]:

lesions of hypothalamus:

tumour of 3rd ventricle

trauma

encephalitis

idiopathic

lesions of stalk:

optic glioma

craniopharyngioma

basal meningitis

section of stalk

hypopituitarism:

Sheehan's syndrome

adenomas

hypophysectomy

radiation

steroid administration:

[suppression of hypothalamic-pituitary-adrenal axis; hypoadrenalism occurs with acute illness or sudden withdrawal of steroids]

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