aetiology
Last reviewed 07/2021
Causes of acute hypoadrenalism include:
- drug related:
- abrupt withdrawal of steroids from patients with adrenal atrophy secondary to chronic steroid administration
- steroid synthesis inhibiting drugs given to patients with congenital adrenal hyperplasia
- steroid metabolism increasing drugs given to patients with decreased adrenocortical reserve
- adrenal crisis - rapid and overwhelming intensification of chronic adrenal insufficiency - may follow trauma, severe hypotension and sepsis
- an acute haemorrhagic destruction of both adrenal glands:
- newborn - birth trauma
- children - usually associated with septicaemia with Pseudomonas or with meningococcaemia (Waterhouse - Friederichsen syndrome)
- adults - anticoagulant therapy or a coagulation disorder during stress
- pregnancy - idiopathic adrenal vein thrombosis; complication of venography
- surgical adrenalectomy e.g. for breast cancer
- pituitary necrosis e.g. Sheehan's syndrome
- inadequate steroid replacement during surgery
Waterhouse-Friderichsen's syndrome