Background: Adrenal inefficiency is often elusive diagnosis that may result in severe morbidity and mortality when undiagnosed or ineffectively treated. It could be primary, secondary to adrenal failure, or secondary to disease or suppression of the hypothalamic pituitary axis. Design and Setting: A retrospective, hospital based study was conducted at the pediatric endocrine clinic, King Khalid University Hospital (KKUH). Riyadh, Saudi, Arabia during the period January 1989 and June 2016. Materials and Methods: The medical records of patients with the diagnosis of adrenal insufficiency were retrospectively reviewed. Data included age, sex, clinical presentation and results of relevant laboratory and radiological investigation. Results: During the period under review, January 1989 and June 2016, a total of 160 patient with adrenal insufficiency were seen. Secondary (central) adrenal insufficiency was seen in 28 (17.5%) patients. Hypothalamic / pituitary tumor, glucocorticoid induced and congenital hypopituitarism were the commonest in 25%, 21.43% and 17.86% respectively. Conclusion: Central adrenal insufficiency in children is rare. A wide spectrum of aetiological causes were seen in our study. Hypothalamic pituitary tumours, glucocorticoid induced and congenital hypopituitarism were the commonest.

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