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 | |
| Â | Infiltrative |
 Neurosarcoidosis | |
 Histiocytosis X | |
 Haemochromatosis | |
| Â | Inflammatory/Infective |
 Hypophysitis (lymphocytic, granulomatous) | |
 Post-basal meningitis, abscesses, encephalitis. | |
| Â | Traumatic/vascular |
 Traumatic brain injury | |
 Subarachnoid haemorrhage | |
 Sheehan’s syndrome | |
| Â | Miscellaneous |
 Idiopathic | |
 Pituitary apoplexy | |
 Empty sella syndrome | |
 Rathkes cleft cyst |