Secondary adrenal insufficiency may occur in Panhypopituitarism Isolated failure of adrenocorticotropic hormone (ACTH) production Patients receiving corticosteroids (by any route, including high doses of inhaled, intra-articular, or topical corticosteroids) Patients who have stopped taking corticosteroids Inadequate ACTH can also result from failure of the hypothalamus to stimulate pituitary ACTH production, which is sometimes called tertiary adrenal insufficiency.