The adrenal cortex supplies the medulla with cortisol via portal venous system where it helps catalyze the conversion from norepinephrine to epinephrine through the enzyme phenylethanolamine-N-mehtyltransferase (PNMT).10 Hence, with Addison’s disease, where the adrenal gland is nonfunctional, epinephrine deficiency will also be present. Here, PNMT is linked to primary adrenal insufficiency.