Table 1.
Causes of central hypoadrenalism
| Congenital | Acquired |
|---|---|
| Genetic | Tumor |
| Isolated ACTH deficiency | Non-functioning pituitary adenoma |
| POMC mutation/cleavage defect | Functional pituitary adenoma |
| Mutations in POMC transcription factors (TBX19) | Craniopharyngioma |
| Pituitary metastases | |
| Associated with other pituitary deficiencies | Germinoma |
| PROP1, LHX3, LHX4, HESX1, OTX2 mutations | Other tumours including astrocytoma, meningioma. |
| Midline Defects | Iatrogenic |
| Septo-optic dysplasia (without HESX1 mutation) | Exogenous glucocorticoids |
| Pituitary surgery | |
| Cranial irradiation | |
| Post-treatment for hypercortisolism | |
| Opiates | |
| Infiltrative | |
| Neurosarcoidosis | |
| Histiocytosis X | |
| Haemochromatosis | |
| Inflammatory/Infective | |
| Hypophysitis (lymphocytic, granulomatous) | |
| Post-basal meningitis, abscesses, encephalitis. | |
| Traumatic/vascular | |
| Traumatic brain injury | |
| Subarachnoid haemorrhage | |
| Sheehan’s syndrome | |
| Miscellaneous | |
| Idiopathic | |
| Pituitary apoplexy | |
| Empty sella syndrome | |
| Rathkes cleft cyst |