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Adrenal insufficiency consists of decreased levels or absence of hormones produced by the adrenal glands and results from structural or functional lesions of the adrenal cortex, the anterior pituitary gland, or the hypothalamus. Deficit of adrenal hormones may manifest clinically as a chronic, insidious disorder, or as an acute, life-threatening emergency. Therapy of adrenal insufficiency is specific and includes replacement of the deficient hormones.
Chronic adrenal insufficiency is due to a variety of causes. It may be primary (Addison's disease), due to failure of the adrenal glands. It also may occur secondarily because of failure of the pituitary gland (hypopituitarism) or as a tertiary insufficiency due to hypothalamic dysfunction. Iatrogenic adrenal suppression from chronic steroid use is termed iatrogenic tertiary adrenal insufficiency. Acute adrenal insufficiency (adrenal crisis) may result from certain acute events, or when a person with chronic adrenal insufficiency is subjected to stress and exhausts reserve adrenal hormones, or when replacement hormone medication is discontinued.
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