Common causes of secondary adrenal insufficiency
| Pituitary tumors Pituitary tumors replacing normal corticotropic cells Adrenocorticotropic hormone deficiency after tumor resection or radiation treatment |
| Nonpituitary tumors Meningioma Craniopharyngioma Sellar or suprasellar metastases (lung, colon, and breast cancer) |
| Pituitary infiltration Granulomatosis with polyangiitis Sarcoidosis Amyloidosis Hemochromatosis Lymphoma |
| Autoimmune Lymphocytic hypophysitis Isolated (usually with pregnancy) Associated with other autoimmune disease (thyroid, vitiligo, type 1 diabetes, pernicious anemia) |
| Sheehan syndrome Infarction in the pituitary gland due to excessive postpartum hemorrhage |
| Pituitary apoplexy Acute hemorrhage in the pituitary adenoma |
| Head trauma Severe head trauma leading to fracture of the skull base and injury in the pituitary gland |
| Drug-induced central adrenal insufficiency See Figure 1 |
| Rare congenital causes Mutations of TBX19 (T-box transcription factor 19) and PCSK1 kexin (proprotein convertase subtilisin) genes Mutations of POMC (proopiomelanocortin) gene |