A 32-year-old woman develops an Addisonian crisis (acute adrenal insufficiency) 3 months after suffering massive hemorrhage during the delivery of her baby. A CT scan of the abdomen shows small adrenal glands. Which of the following mechanisms of disease best accounts for adrenal atrophy in this patient?

Lack of trophic signals. Atrophy of an organ may be caused by interruption of key trophic signals. Postpartum infarction of the anterior pituitary in this patient resulted in decreased production of adrenocorticotropic hormone (ACTH, also termed corticotropin). Lack of corticotropin results in atrophy of the adrenal cortex, which leads to adrenal insufficiency. Symptoms of acute adrenal insufficiency (Addisonian crisis) include hypotension and shock, as well as weakness, vomiting, abdominal pain, and lethargy. The other choices are unlikely causes of postpartum adrenal insufficiency.Diagnosis: Sheehan syndrome, adrenal insufficiency