TABLE 1

Common causes of primary adrenal insufficiency

Autoimmune
Isolated
Autoimmune polyglandular syndrome type 1
Autoimmune polyglandular syndrome type 2
Adrenal infection
Tuberculosis
Human immunodeficiency virus
Cytomegalovirus
Fungal infections: candidiasis, histoplasmosis, paracoccidioidomycosis
Syphilis
African trypanosomiasis
Adrenal metastases
Breast, lung, colon, stomach cancers or lymphoma
Adrenal hemorrhage
Trauma
Anticoagulation
Antiphospholipid syndrome
Congenital adrenal hyperplasia
21-hydroxylase deficiency
11-hydroxylase deficiency
3B-hydroxysteroid dehydrogenase II deficiency
Drug-induced primary adrenal insufficiency
Adrenal enzyme inhibitors: mitotane, ketoconazole, metyrapone, etomidate
Drugs that accelerate cortisol metabolism: fluconazole, phenytoin, rifampin, barbiturates
Immune checkpoint inhibitors
 Anti-PD-1 (programmed cell death protein 1) monoclonal antibodies: pembrolizumab, nivolumab
 CTLA-4 (cytotoxic T-lymphocyte antigen 4) inhibitor: ipilimumab
Others
Adrenoleukodystrophy and adrenomyeloneuropathy
Familial glucocorticoid deficiency
Familial glucocorticoid resistance