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Although the original definition of Addison's disease described the failure of the adrenals, some in the medical field also refer to pituitary failure to stimulate cortisol as Addison's. To clear up confusion, many medical organizations are now using the terms Primary Adrenal Insufficiency to describe cortisol deficiency from direct failures of the adrenal glands, and Secondary Adrenal Insufficiency to describe cortisol deficiency from an indirect failure of the pituitary to signal cortisol by the adrenal glands. Primary causes include autoimmune destruction, damage from diseases such as TB, hemorrhaging of adrenals, Congenital Adrenal Hyperplasia, as well as adrenalectomy surgery to remedy Cushing's disease. Secondary causes include pituitary tumors, empty sella syndrome, Sheehan's syndrome and long term steroid use for conditions such as asthma. Sometimes the cause of secondary A.I. cannot be determined.