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What causes secondary adrenal insufficiency?

Secondary adrenal insufficiency can be traced to a lack of adrenocorticotropic hormone (ACTH). Without ACTH to stimulate the adrenal glands, the adrenals' production of cortisol drops. Aldosterone production is not usually affected.

A temporary form of secondary adrenal insufficiency may occur when a person who has been taking synthetic glucocorticoid hormone such as prednisone for a long time stops taking the medication, either abruptly or gradually. Glucocorticoid hormones, which are often used to treat inflammatory illnesses such as rheumatoid arthritis (RA), asthma, and ulcerative colitis, block the release of both corticotropin-releasing hormone (CRH) and ACTH. As a result, the adrenals may begin to atrophy-or shrink-from lack of ACTH stimulation and then fail to secrete sufficient levels of cortisol.

A person who stops taking synthetic glucocorticoid hormone may have enough ACTH to function when healthy. However, when a person is under the stress of an illness, an accident, or surgery, his or her body may not have enough ACTH to stimulate the adrenal glands to produce cortisol.

Another cause of secondary adrenal insufficiency is surgical removal of the noncancerous, ACTH-producing tumors of the pituitary gland that cause Cushing's disease. Cushing's disease is another disorder that leads to excess cortisol in the body. In this case, the source of ACTH is suddenly removed and replacement hormone must be taken until normal ACTH and cortisol production resumes.

Less commonly, adrenal insufficiency occurs when the pituitary gland either decreases in size or stops producing ACTH. These events can result from:

Tumors or infections of the area Loss of blood flow to the pituitary Radiation for the treatment of pituitary tumors Surgical removal of parts of the hypothalamus Surgical removal of the pituitary gland This answer is based on source  information from the National Institute of Diabetes and Digestive and Kidney Diseases.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.