While secondary or tertiary adrenal insufficiency (isolated glucocorticoid deficiency) does not lead to volume depletion, it decreases vascular tone, which leads to hypotension. Thus, adrenal crisis occurs less frequently in patients with secondary or tertiary adrenal insufficiency. When they do have adrenal crisis, it tends to be during acute stress, or with acute cortisol deficiency due to pituitary infarction or after surgical cure of Cushing's syndrome. (See "Clinical manifestations of adrenal insufficiency in adults", section on 'Secondary/tertiary adrenal insufficiency' .)
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