title: Central hypoadrenalism.
abstract: BACKGROUND
  Central hypoadrenalism is a frequent complication of pituitary and hypothalamic pathology and is associated with increased morbidity and mortality. Optimal exogenous glucocorticoid use is dependent on the use of appropriate diagnostic tests and careful assessment of the clinical response to glucocorticoid replacement therapy.
  
  
  METHODS
  A PubMed search for the terms central hypoadrenalism, ACTH deficiency, glucocorticoid suppression, and glucocorticoid replacement was conducted; the papers identified and the references listed were used to build a reference list.
  
  
  RESULTS
  The published literature was assessed to present a summary of the available evidence with regard to etiology, diagnosis, and treatment of central hypoadrenalism.
  
  
  CONCLUSIONS
  A functional hypothalamic pituitary adrenal axis is essential for normal health and life expectancy; its complexity presents challenges to the clinician in the identification of patients and in the maintenance of such patients in a glucocorticoid-sufficient state. The most common cause of central hypoadrenalism remains exogenous glucocorticoid use. Further research in this field should be directed toward disease prevention by minimizing glucocorticoid exposure and toward the identification of a biomarker for glucocorticoid sufficiency that will aid clinicians in optimizing treatment.
authors.affiliation: Centre for Endocrinology Diabetes and Metabolism (R.K.C., N.A., J.W.T.), University of Birmingham, Edgbaston B15 2TT, United Kingdom; and University of Leeds School of Medicine (P.M.S.), Leeds LS2 9NL, United Kingdom.
authors.forename: R K
authors.initials: RK
authors.lastname: Crowley
authors.forename: N
authors.initials: N
authors.lastname: Argese
authors.forename: J W
authors.initials: JW
authors.lastname: Tomlinson
authors.forename: P M
authors.initials: PM
authors.lastname: Stewart
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D010900:Pituitary Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology*