POMC and Adrenal insufficiency: Adrenal size could be considered another marker of adrenal activity, as hypertrophic/hyperplastic adrenal glands could be the result of an ACTH over-stimulation by the pituitary, as seen in subjects exposed to chronic stress [125, 126], whereas a diminished or atrophic gland may reflect adrenal insufficiency at any level of the HPA axis [98].