In primary adrenal insufficiency, the adrenal gland fails to produce cortisol. In addition to autoimmune and infectious etiologies, this can be caused by bilateral adrenal hemorrhage, metastases, sarcoidosis, amyloidosis, adrenalectomy (such as in the case of resistant Cushing's syndrome), acquired immune deficiency syndrome (AIDS), antiphospholipid syndrome, or medication-induced effects (such as antineoplastics, etomidate, ketoconazole, and mifepristone).3 Secondary adrenal insufficiency, in which the pituitary gland produces insufficient ACTH, is typically caused by a regional tumor, autoimmune causes, genetic mutations, pituitary apoplexy postpartum (Sheehan's syndrome), head trauma, or chronic exogenous glucocorticoid administration.