The pituitary gland is responsible for producing ACTH, which travels to the adrenal gland's cortex to facilitate the release of its target hormone, cortisol. In diseases like malignancy, infection, or autoimmune disease, the functionality of the pituitary gland may be altered and affect its ability to release hormones to stimulate the adrenal gland. Signs and symptoms include, but are not limited to, dizziness, weakness, fatigue, muscle pain, dark urine, hyperpigmentation of the skin, and an increased craving for salty foods.
Laboratory tests to diagnose secondary adrenal insufficiency are similar to that of primary. Initial blood hormone levels would reveal low cortisol to match with clinical signs and symptoms. ACTH stimulation tests can be performed.
Synthetic ACTH can be administered to these patients, which would ultimately increase cortisol production.
Table 4. Adrenal Insufficiency (Hypoadrenalism).| Hypoadrenalism |
| Pathology | Hormone Levels in the Body | Responsible Organ |
| Primary (Addison's) | ↓↓Cortisol, ↑↑ACTH, ↑↑CRH | Adrenal Gland |
| Secondary | ↓↓Cortisol, ↓↓ACTH, ↑↑CRH
| Pituitary Gland |
| Tertiary | ↓↓Cortisol, ↓↓ACTH, ↓↓CRH
| Hypothalamus |
