<unk>  insufficiency occurs when the<unk>  glands fail to supply the physiologic demands of the body for glucocorticoids (cortisol) and/or mineralocorticoids (aldosterone).
Divided into primary<unk>  insufficiency or secondary<unk>  insufficiency<unk>  is the acute, life-threatening presentation of<unk>  insufficiency
8-47% of patients with primary<unk>  insufficiency will have at least one<unk>  in their lives
Consider in any patient with unexplained hypotension (especially in those with HIV or taking exogenous steroids)
Generally caused by mineralocorticoid deficiency, not glucocorticoid deficiency
This is the reason<unk>  occur much more frequently with primary<unk>  insufficiency
8-47% of patients with primary<unk>  insufficiency will have at least one<unk>  in their lives
Consider in any patient with unexplained hypotension (especially in those with HIV or taking exogenous steroids)
Generally caused by mineralocorticoid deficiency, not glucocorticoid deficiency
This is the reason<unk>  occur much more frequently with primary<unk>  insufficiency
This is the reason<unk>  occur much more frequently with primary<unk>  insufficiency
Primary<unk>  insufficiency (decreased cortisol and aldosterone)
Autoimmune (70%)<unk>  hemorrhage
Coagulation disorders
Sepsis (Waterhouse-Friderichsen syndrome)
Meds
Infection (HIV, TB)
TB is most common worldwide cause primary<unk>  insuffiency
Sarcoidosis/amyloidosis
Metastases
CAH
Secondary<unk>  insufficiency (decreased ACTH → decreased cortisol only)
Withdrawal of steroid therapy
Pituitary disease
Head trauma
Postpartum pituitary necrosis
Infiltrative disorders of pituitary or hypothalamus
Autoimmune (70%)<unk>  hemorrhage
Coagulation disorders
Sepsis (Waterhouse-Friderichsen syndrome)
Meds
Infection (HIV, TB)
TB is most common worldwide cause primary<unk>  insuffiency
Sarcoidosis/amyloidosis
Metastases
CAH
Coagulation disorders
Sepsis (Waterhouse-Friderichsen syndrome)
TB is most common worldwide cause primary<unk>  insuffiency
Withdrawal of steroid therapy
Pituitary disease
Head trauma
Postpartum pituitary necrosis
Infiltrative disorders of pituitary or hypothalamus
Increased demand
Infection
MI
Surgery
Trauma
Decreased supply
Discontinuation of steroid therapy
Infection
MI
Surgery
Trauma
Discontinuation of steroid therapy
Adrenal crisis
Cardiogenic
Diabetic ketoacidosis 
Acute valvular Regurgitation/VSD
Diabetic ketoacidosis
CHF
Thyroid storm
Dysrhythmia