Tertiary Adrenal Insufficiency

• Tertiary adrenal insufficiency results from inadequate corticotropin-releasing hormone (CRH) release by the hypothalamus. This is usually the result of patients taking long-term oral steroids (for more than 3 weeks), causing suppression of the hypothalamus (via negative feedback). Therefore, long-term steroids must be tapered slowly to allow the adrenal axis to regain normal function.
• • Tertiary adrenal insufficiency occurs when hypothalamic production of corticotropin-releasing hormone is disrupted and production of ACTH from the anterior pituitary is insufficient. Causes include long-term administration of corticosteroids and less commonly tumours, radiotherapy, or surgery affecting the hypothalamus.