TNF and Hyperglycemia: The cause of stress hyperglycemia in ACS could be due to increased activity of neurohormonal pathways such as catecholamines, cortisol and growth hormone which produce significant insulin resistance.27 The activation of circulating cytokines such as tumor necrosis factor-α may lead to reduction of insulin sensitivity, thus increase serum level of glucose.28,29 Investigating a cause and effect relationship between stress hyperglycemia and ACS requires other future studies with different design.