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Related to secondary adrenal insufficiency: tertiary adrenal insufficiency, Acute Adrenal Insufficiency
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The hypothalamic-pituitary-adrenocortical axis suppression and primary and secondary adrenal insufficiency has been reported in severe falciparum malaria (10).
The presence of secondary adrenal insufficiency as determined by ACTH stimulation testing was required for inclusion.
Another cause of secondary adrenal insufficiency is the surgical removal of benign, or noncancerous, ACTH-producing tumors of the pituitary gland (Cushing's disease).
Hormonal investigations revealed hypopituitarism in the form of GH deficiency, central hypothyroidism, secondary adrenal insufficiency, secondary hypogonadism with hyperprolactinemia; the skull x- ray and standard sellar computed tomography (CT) were normal (9).
Our observation of the absence of increase in the F/E ratio after ACTH in patients with secondary adrenal insufficiency also argues against the inhibitory effect of ACTH on 11-HSD-2 activity, but in hypocortisolic patients.