Secondary adrenal insufficiency

The disease is caused by adrenal insufficiency in the absence of ACTH. Secondary adrenal insufficiency can occur in hypopituitarism, and patients with a lack of single ACTH production and receiving corticosteroids after discontinuing corticosteroids. Total hypopituitarism is most common in women with Sheehan syndrome, but it can also occur in chromocytoma, younger patients with craniopharyngioma and various tumors, granulomas, and rare trauma infections that cause the pituitary Organization destruction. Patients receiving corticosteroids for more than 4 weeks or discontinuing treatment for weeks to months, did not have enough ACTH secretion during stress to excite the adrenal glands to produce sufficient corticosteroids, or did not respond to ACTH due to adrenal cortical atrophy. This phenomenon persisted until 1 year after steroid treatment was stopped. During the long-term steroid treatment, the hypothalamic-pituitary-adrenal axis integrity can be determined by intravenous injection of 5 ~ 250 μg of tecotecide. After 30 minutes, the plasma cortisol level should be 20 μg / dl (552 nmol / L). The lack of a single ACTH is idiopathic and extremely rare.