We used identical diagnostic algorithms in the bTBI and nbTBI groups, excluded the presence of macroprolactin, applied strict normal ranges for diagnosing testosterone and TSH deficiency, performed 2 stimulation tests to confirm ACTH or GH deficiencies, and adjusted for the confounds of age and obesity in diagnosing GH deficiency.22 This allows us to be confident of our reported prevalence of pituitary dysfunction in both groups.6,7. Here, POMC is linked to obesity due to melanocortin 4 receptor deficiency.