Addison's disease occurs when >90% of adrenal tissue is destroyed. The most common cause is autoimmune destruction (alone, or as part of type I or type II polyglandular autoimmune syndromes). Tuberculosis used to be the leading etiology. Other granulomatous diseases (histoplasmosis, coccidioidomycosis, cryptococcosis, sarcoidosis), bilateral adrenalectomy, bilateral tumor metastases, bilateral hemorrhage, CMV, HIV, amyloidosis, and congenital diseases (some types of congenital adrenal hypoplasia, adrenal hypoplasia congenita, and adrenoleukodystrophy) are additional etiologies.