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1 out of 8

Most common cause of adrenal insufficiency in India (AIIMS May 2011)

A Autoimmune
B Surgery

C Steroid withdrawal
D Tuberculosis

Ans. D


Adrenocortical insufficiency or hypofunction may be

1). Primary adrenal Disease

2). Secondary hypoadrenalism (decreased stimulation of ACTH due to deficiency of ACTH).

Primary adrenocortical insufficiency

Table - Classification of Adrenal Insufficiency (Ref. Hari - 18th ed. Pg- 2955 Table 342.7)

1). Primary Adrenal Insufficiency

a. Anatomic destruction of gland (chronic or acute)

i. "Idiopathic" atrophy (autoimmune)

ii. Surgical removal

iii. Infection (tuberculous, fungal, viral—especially in AIDS patients)

iv. Hemorrhage

v. Invasion: metastatic (The most common site of primary in a patient presenting with secondries to adrenals is Melanoma.) Lung, Breast, lymphoma, RCC

b. Metabolic failure in hormone production

i. Congenital adrenal hyperplasia

ii. Enzyme inhibitors (metyrapone, ketoconazole, aminoglutethimide)

iii. Cytotoxic agents (mitotane)

iv. Adrenal hypoplasia congenital

2). Secondary Adrenal Insufficiency

a. Hypopituitarism due to hypothalamic-pituitary disease

b. Suppression of hypothalamic-pituitary axis

i. By exogenous steroid

ii. By endogenous steroid from tumor