Production of cortisol is controlled by the action of ACTH produced
pituitary gland. The pituitary gland is regulated by
hypothalamus in the brain. If either the
hypothalamus or pituitary gland is damaged, less ACTH
is produced, leading to underfunctioning of the adrenal glands and reduced
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Previous radiation of the hypothalamus or pituitary
Previous surgery to the pituitary gland.
conditions such as
sarcoidosis, or Sheehan's syndrome (hypopituitarism).
Sheehan's syndrome is occasionally caused by severe blood loss after delivering
The symptoms of secondary adrenocortical insufficiency are similar to
Addison's disease, except that darkening of the skin
(hyperpigmentation) and high levels of potassium in the blood are not present.
With secondary adrenocortical insufficiency, only cortisol is low.
The adrenal glands can still make normal amounts of aldosterone. Symptoms
Fatigue and muscle weakness that gradually become
worse over time.
Diagnosis starts with a medical history and physical examination. If
your doctor suspects adrenal insufficiency, he or she will check your blood
cortisol and ACTH levels. Your doctor may recommend imaging tests of the
adrenal glands, the pituitary gland, or the hypothalamus.
If your doctor suspects secondary adrenocortical insufficiency, you
may get infusions of ACTH on two consecutive days. In most cases, even if you
have problems with the
adrenal glands will make cortisol by the end of the
second treatment. If possible, your doctor will treat the condition that is
causing secondary adrenocortical insufficiency. Your doctor may start treatment
during the testing if he or she thinks adrenal insufficiency is likely. If
treatment is found to be unnecessary, it can be stopped after testing is
CT scan or
MRI can be used to see
whether there is evidence of damage to the brain or pituitary gland (such as a
tumor) that is causing adrenal failure.