Which condition would be least likely to cause adrenal insufficiency?

Which condition would be least likely to cause adrenal insufficiency?

• A. Adrenal adenoma
• B. Pituitary tumor
• C. Hypophysectomy
• D. Abrupt discontinuation of corticosteroids

Answer: (A)

Adrenal insufficiency arises when cortisol (and often aldosterone) production falls because the adrenal axis is destroyed or suppressed, whether at the adrenal gland itself (primary), at the pituitary (secondary, due to low ACTH), or after stopping exogenous steroids (tertiary due to axis suppression). An adrenal adenoma is the least likely to cause this. If the adenoma is functional, it usually drives excess hormone production, most commonly cortisol (leading to Cushing syndrome) rather than deficiency. Even nonfunctioning unilateral adrenal adenomas generally don’t cause adrenal insufficiency because the opposite adrenal gland can compensate, and the problem isn’t destruction or suppression of the axis. In contrast, a pituitary tumor can reduce ACTH output (secondary insufficiency), removing ACTH entirely with hypophysectomy (surgical removal) guarantees loss of ACTH and cortisol production, and abrupt withdrawal of corticosteroids can precipitate tertiary/adrenal insufficiency by leaving the axis suppressed and unable to resume adequate cortisol production quickly.

Adrenal insufficiency arises when cortisol (and often aldosterone) production falls because the adrenal axis is destroyed or suppressed, whether at the adrenal gland itself (primary), at the pituitary (secondary, due to low ACTH), or after stopping exogenous steroids (tertiary due to axis suppression).

An adrenal adenoma is the least likely to cause this. If the adenoma is functional, it usually drives excess hormone production, most commonly cortisol (leading to Cushing syndrome) rather than deficiency. Even nonfunctioning unilateral adrenal adenomas generally don’t cause adrenal insufficiency because the opposite adrenal gland can compensate, and the problem isn’t destruction or suppression of the axis.

In contrast, a pituitary tumor can reduce ACTH output (secondary insufficiency), removing ACTH entirely with hypophysectomy (surgical removal) guarantees loss of ACTH and cortisol production, and abrupt withdrawal of corticosteroids can precipitate tertiary/adrenal insufficiency by leaving the axis suppressed and unable to resume adequate cortisol production quickly.