Hiv Aids

• Mycobacterial, cytomegaloviral, Pneumocystic jiroveci, and Toxoplasma gondii infection

• Sarcoidosis

• Tuberculosis

• Medications—inhibitors of steroidogenesis (etomidate, ketoconazole, metyrapone, mitotane)

• Hemorrhagic

• Bilateral adrenal hemorrhage or infarction—usually due to anticoagulant therapy, coagulopathy, thromboembolic disease, or meningococcal infection. Causes acute adrenal insufficiency

• Adrenalectomy

• Adrenoleukodystrophy (in males)

• Adrenomyeloneuropathy

• Infiltrative disorders—amyloidosis, hemochromatosis

• Genetic causes

• Congenital adrenal hyperplasia

• Familial glucocorticoid deficiency and hypoplasia

• Metastatic malignancy Secondary Adrenal Insufficiency

• Drug-induced (most common cause of secondary adrenal insufficiency)

• Chronic glucocorticoid administration at supraphysiologic doses

• Megestrol acetate—has glucocorticoid-like activity

• Mifepristone (RU 486)—antagonizes glucocorticoid receptors

• Cushing's syndrome

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