The . Food and Drug Administration (the government agency that oversees most food and medical products) does not oversee nutritional supplements and vitamins. This means there is no guarantee that what's on the label of a supplement is really what's inside the bottle. In some cases, supplements have very few, if any, active ingredients. In other cases, the dose of a particular ingredient may be too high. This is true if you purchase supplements from your local drug store or a specialty pharmacy (sometimes called a compounding pharmacy) where supplements are made directly by the pharmacist.
While secondary or tertiary adrenal insufficiency (isolated glucocorticoid deficiency) does not lead to volume depletion, it decreases vascular tone, which leads to hypotension. Thus, adrenal crisis occurs less frequently in patients with secondary or tertiary adrenal insufficiency. When they do have adrenal crisis, it tends to be during acute stress, or with acute cortisol deficiency due to pituitary infarction or after surgical cure of Cushing's syndrome. (See "Clinical manifestations of adrenal insufficiency in adults", section on 'Secondary/tertiary adrenal insufficiency' .)