POMC and Hypoalbuminemia: Some studies [1-3], but not all, indeed suggest that (total) cortisol values increase and ACTH-induced increases diminish with increasing Acute Physiology and Chronic Health Evaluation II score or other disease severity and organ failure scores, unless limited by progressive and severe hypoalbuminaemia and decreased cortisol binding [1-3,7,10,19,21-23].