![]() Hyperpigmentation does not occur with secondary adrenal insufficiency because it is related to melanocytic stimulation factors produced from the same precursor as ACTH. ![]() Therefore, hypotension and electrolyte disturbances are usually absent or less severe than with primary adrenal failure. Usually, production of aldosterone is partially preserved because its primary regulation is by angiotensin and potassium levels. Secondary adrenal insufficiency results from decreased levels of adrenocorticotropin (ACTH). Suspicion of secondary adrenal insufficiency may be raised by a low serum cortisol level or a history of long-term steroid therapy, head trauma, head irradiation, pituitary tumors, pituitary surgery, or other processes that may impair the hypothalamic-pituitary-adrenal axis. Secondary and tertiary adrenal insufficiency may present with nonspecific symptoms of fatigue, weakness, and hypoglycemia.
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