Idiopathic autoimmune Addison disease may occur in isolation or in
combination with other autoimmune diseases, such as diabetes mellitus type
I, systemic lupus erythematosus, Hashimoto thyroiditis, Graves disease,
vitiligo, alopecia (areata, totalis, universalis), pernicious anemia,
myasthenia gravis, idiopathic hypophysitis, idiopathic hypoparathyroidism,
primary biliary cirrhosis, and chronic active hepatitis. Other diseases may
have the potential to cause Addisonian syndrome (e.g. tuberculosis,
sarcoidosis, blastomycosis, histoplasmosis, cryptococcosis, meningococcemia,
AIDS, cytomegalovirus infection). Hodgkin and non-Hodgkin lymphomas and
metastases from different carcinomas (lung, breast, kidney) may affect the
adrenal glands. Addisonian syndrome in patients with Allgrove Syndrome
is caused by a congenital adrenocortical unresponsiveness to ACTH. Several
drugs may interfere with adrenal steroidogenesis (ketoconazole, busulfan,
etomidate, aminoglutethimide) or ACTH storage in the pituitary (methadone).
Addisonian syndrome has been described as a complication of pregnancy and
anticoagulant therapy with heparin or warfarin resulting in adrenocortical
hemorrhage. Heparin-induced (thrombocytopenia and) thrombosis may result in
thrombosis of adrenal vessels followed by necrosis of the gland. An acute
adrenal crisis can be precipitated by trauma, surgery, and significant
physical and/or emotional stress. Another common cause of an adrenal crisis
is the failure to appropriately replace steroids in patients receiving
long-term steroid medication.