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Table 1 Causes of central hypoadrenalism

From: How should we interrogate the hypothalamic-pituitary-adrenal axis in patients with suspected hypopituitarism?

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