Acute adrenal hypofunction may develop during acute injury or disease in patients with known hypoadrenalism or may be the first presentation. The stress of injury unmasks a pre-existing insufficient hypothalamic-pituitary-adrenal axis in these patients. Acute hypoadrenalism can also develop with adrenal hemorrhage. In critically ill patients the adrenal response to stress may be insufficient to meet the metabolic demands, and this condition is referred to as relative de novo hypoadrenalism. Deficient aldosterone production can occur in conditions other than Addison's disease.

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