The most common cause of adrenal insufficiency is

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Adrenal insufficiency happens when the adrenal cortex cant produce enough cortisol. The most common cause, especially in developed regions, is autoimmune destruction of the adrenal cortex. In autoimmune Addison’s disease, the immune system attacks cortisol-producing cells (often targeting enzymes like 21-hydroxylase), gradually destroying the cortex. This leads to reduced cortisol and often reduced aldosterone, producing symptoms such as fatigue, weight loss, and low blood pressure, and can be associated with other autoimmune conditions.

Long-term steroid use can suppress the hypothalamic-pituitary-adrenal axis and cause secondary adrenal insufficiency, but that is a suppression of ACTH rather than destruction of the adrenal cortex itself. Infections that destroy the adrenal glands and adrenal trauma are less common causes overall.