Which of the following conditions signifies a secondary cause of adrenal insufficiency?

Adrenal insufficiency can be classified into primary and secondary causes. A secondary cause refers specifically to issues outside the adrenal glands that impact their function, particularly relating to the hypothalamic-pituitary-adrenal (HPA) axis.

Hypopituitarism is a condition where the pituitary gland does not produce sufficient amounts of one or more of its hormones, which can lead to a deficiency in adrenocorticotropic hormone (ACTH). Since ACTH is essential for stimulating the adrenal glands to produce cortisol, a deficiency in ACTH means the adrenal glands cannot respond appropriately to physiological stress, resulting in adrenal insufficiency. This clearly identifies hypopituitarism as a secondary cause, as it originates from pituitary dysfunction rather than a direct adrenal pathology.

In contrast, autoimmune destruction is typically a primary cause of adrenal insufficiency, where the adrenal glands are directly attacked by the body’s immune system, leading to a failure in cortisol production. Infection can lead to adrenal insufficiency as well, but it predominantly affects the adrenal glands directly (for example, in cases of adrenalitis). Similarly, adrenal hemorrhage refers to bleeding in the adrenal glands, which again points to a direct issue with the adrenal glands themselves. Therefore, these conditions are not