Tertiary adrenal insufficiency is due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH).Secondary adrenal insufficiency is caused by impairment of the pituitary gland or hypothalamus. Its principal causes include pituitary adenoma (which can suppress production of adrenocorticotropic hormone (ACTH) and lead to adrenal deficiency unless the endogenous hormones are replaced) and Sheehan’s syndrome, which is associated with impairment of only the pituitary gland.Other cases are due to congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland.
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