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Adrenal insufficiency occurs when the adrenal gland fails to provide adequate levels of the stress hormone cortisol. This may occur through failure of the adrenal gland itself (primary adrenal failure commonly called Addison’s disease) or failure of the pituitary gland to stimulate normal cortisol levels from the adrenal gland (secondary adrenal insufficiency).
In addition, adrenal insufficiency may occur in patients treated with steroids, which suppresses cortisol secretion and results in a temporary and occasionally permanent adrenal insufficiency, called tertiary adrenal insufficiency.1
Primary adrenal insufficiency or Addison’s disease occurs in approximately 1 in 10 to 15,000 people and is more commonly found in women as autoimmunity is more common in women. Secondary adrenal insufficiency due to pituitary failure is twice as common as Addison’s disease and can affect both sexes equally.1
Adrenal insufficiency can be classified into primary, secondary, and tertiary causes. Primary adrenal insufficiency occurs when there is a pathology affecting the adrenal gland itself. Secondary adrenal insufficiency results from a decreased level of adrenocorticotropic hormone (ACTH) released from the pituitary gland, and tertiary adrenal insufficiency results from a decreased level of corticotrophin-releasing hormone (CRH) released from the hypothalamus.
1. Huecker MR, Bhutta BS, Dominique E. Adrenal Insufficiency. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441832/
